The average American family now pays more than $2,200 a month for health insurance, a figure that exceeds the roughly $2,000 average monthly mortgage payment. That single comparison, drawn from a recent analysis sponsored by Americans for Limited Government, tells you most of what you need to know about the state of the healthcare system more than a decade after the Affordable Care Act was supposed to make coverage affordable.
The numbers behind that headline are worth sitting with. Among the 312 insurers participating in ACA Marketplace plans, premiums for 2026 rose anywhere from 12 to 27 percent for most enrollees. Some insurers hiked rates as high as 59 percent in a single year. Families across the country are not choosing between a better plan and a cheaper plan. They are choosing between medication and meals, skipping prescriptions, and delaying procedures they need.
None of this was supposed to happen. The ACA was sold as the fix, the law that would bend the cost curve down and make insurance accessible to every American. Instead, it created a subsidy pipeline that funnels taxpayer money to corporate insurers while everyday Americans watch their premiums climb year after year.
In 2024, 87 percent of insurer revenues from ACA premiums were taxpayer-funded. That figure was ten percentage points higher than before Covid-era credits expanded the subsidy pipeline. Read that again: nearly nine out of every ten dollars flowing to ACA insurers came from taxpayers, not policyholders.
The architecture of the ACA made this inevitable. Subsidies shield consumers from sticker shock just enough to keep enrollment numbers up, but the money still flows, from the Treasury, through the exchange, and into the revenue lines of massive insurance conglomerates. The consumer sees a manageable monthly bill. The taxpayer sees a growing national tab. The insurer sees both.
A recent poll found that 90 percent of Americans say health insurance companies have too much control and should be broken up. Seventy-four percent strongly agreed. That kind of consensus is rare in American politics. It suggests that whatever the ACA's architects intended, the public sees a system that works for the companies, not the patients.
The Obama era produced no shortage of grand promises about what government-managed healthcare would deliver. The track record of those promises, from energy projects that never performed as advertised to a healthcare law that made insurance more expensive, tells a consistent story about the gap between progressive ambition and real-world results.
The cost crisis is not just about premiums. It is about what insurers do with the money once they get it, and how they game federal programs to get more.
UnitedHealth, described as a $400 billion healthcare behemoth covering more than 8 million Medicare Advantage enrollees, is at the center of a recent Senate investigation. The allegation: the company aggressively gamed Medicare Advantage to inflate its reimbursements from the federal government. The mechanism is straightforward. Insurers find more diagnoses, inflate the severity of conditions, and bill the government accordingly.
UnitedHealth is not alone. The Cigna Group paid $172 million to resolve False Claims Act allegations, according to a Department of Justice press release. Kaiser Permanente affiliates paid $556 million to settle similar charges. These are not small-dollar compliance disputes. They are nine-figure settlements involving allegations that insurers defrauded the federal government, which is to say, defrauded taxpayers.
The pattern is clear enough. The ACA expanded the role of government in healthcare. Government programs became larger revenue streams for insurers. Larger revenue streams attracted more aggressive billing practices. And when those practices crossed the line, the settlements came, but only after the money had already flowed.
Obama's broader political legacy continues to produce consequences that his supporters rarely acknowledge. Whether the subject is foreign policy decisions that look worse with each passing year or a healthcare law that enriched the very corporations it was supposed to regulate, the results speak for themselves.
Premiums are only part of the burden. Americans for Limited Government also targets Pharmacy Benefit Managers, the middlemen who sit between drug manufacturers, insurers, and patients. The accusation is blunt: PBMs increase the price of medicine to pad their own margins.
The average patient sees none of the negotiations that determine what a drug costs at the pharmacy counter. PBMs negotiate rebates with manufacturers, manage formularies for insurers, and take a cut at every step. The system is opaque by design. Patients pay what they are told to pay, and the middlemen collect.
President Trump has moved to address this. He championed the Task Force to Eliminate Fraud and is demanding price transparency through the TrumpRx initiative, which aims to give Americans visibility into the pricing of everyday medicines. He is also going after PBM middlemen directly. Whether these efforts produce lasting structural reform depends on whether Congress and the regulatory apparatus follow through, but the direction is the right one.
The contrast with the Obama-era approach is instructive. The ACA added layers of regulation, created new subsidies, and expanded government's footprint in healthcare, all while leaving the underlying cost drivers untouched. Trump's approach targets the middlemen and the opacity that allow costs to balloon in the first place.
Americans for Limited Government also calls for cracking down on price gouging and fraud from "nonprofit" hospitals. The scare quotes are earned. Many hospitals operating under nonprofit tax status charge prices that rival or exceed their for-profit competitors. They receive tax exemptions meant for charitable institutions while billing patients and insurers at rates that suggest anything but charity.
This is another area where the ACA's expansion of coverage did not translate into affordable care. More people gained insurance. More insurance dollars flowed to hospitals. But the prices those hospitals charged did not come down. In many cases, they went up, because the system rewarded volume and billing complexity, not efficiency or value.
The Obama political machine has continued to shape American institutions long after the presidency ended, from judicial appointments that still generate controversy to a healthcare law that reshaped one-sixth of the American economy. The question is whether the country can finally reform the structures that law put in place.
The case for action is not complicated. Premiums are rising faster than wages. Taxpayers are funding the vast majority of ACA insurer revenues. Major insurers have paid hundreds of millions to settle fraud allegations. PBMs operate in the dark. And hospitals with "nonprofit" status charge prices that would make a for-profit blush.
President Trump's fraud task force and price transparency push represent a different theory of reform than the one Democrats have offered. Instead of adding more subsidies on top of a broken system, the approach targets the incentives that make the system broken. Transparency forces competition. Fraud enforcement recovers taxpayer dollars. Going after middlemen removes a layer of cost that adds no value for patients.
Democrats and liberals, for their part, continue to defend the ACA framework and push for expanded subsidies. But the 2024 numbers undercut that argument on its face. When 87 percent of ACA premium revenues come from taxpayers, the program is not helping families afford insurance. It is helping insurers collect revenue with a government guarantee. The subsidy does not reduce the cost of care. It shifts who pays, from the patient to the taxpayer, while the total bill keeps growing.
Obama-backed political efforts continue to lose ground with voters who see through the promises. Recent electoral results suggest the public is ready for a different direction, even if Washington's entrenched interests are not.
The ACA is now old enough to be judged by results, not intentions. The results are a $2,200 monthly premium for the average family, double-digit rate hikes across hundreds of insurers, nine-figure fraud settlements from industry giants, and a subsidy system that functions as a taxpayer-funded revenue guarantee for corporate healthcare.
People are skipping prescriptions. They are delaying procedures. They are making choices no family in the wealthiest country on earth should have to make, not because the system lacks money, but because the money flows to the wrong places.
When your health insurance costs more than your mortgage, the system is not working for you. It is working for someone. And the people it is working for have lobbyists, legal teams, and a law named after the president who gave them the keys.
