The insurance Coverage Squeeze Is Reshaping Healthcare

Every year, open enrollment forces Americans to confront a familiar dilemma: Pay more for coverage that delivers less, or gamble on going without it. This year, that choice has become even starker. 

Employers are shifting more costs to workers, marketplace premiums are poised to rise, fewer prescription drugs are covered by insurance, and 3.8 million people could lose insurance annually if Affordable Care Act subsidies aren’t extended. 

Together, these developments represent a structural break in the U.S. healthcare system. It’s a perfect storm that will price many Americans out of health insurance altogether—many involuntarily, but some voluntarily. Fed up with skyrocketing premiums and deductibles that offer little protection, they’ll instead pay out-of-pocket for medical needs, hoping that they won’t face catastrophic expenses. 

What’s emerging is not a temporary coverage gap. It’s a permanent coverage squeeze. One that will fundamentally reorder consumer behavior and redefine what “access” means. The implications for healthcare organizations are profound, and those who fail to adapt will struggle to stay relevant.  

SHIFT FROM COVERAGE TO CONTROL 

For decades, the U.S. healthcare model has been built on the assumption that insurance is the gateway to care. But when premiums and deductibles reach levels that rival a second mortgage, consumers start to ask a different question: What am I actually getting for this? 

Increasingly, the answer feels out of step with consumer expectations. High deductibles mean many people pay full price for most of their care anyway. Network limitations constrain choice. Surprise bills erode trust. And the complexity of benefits makes it nearly impossible to be an informed consumer. 

As a result, we’re seeing a quiet but significant reorientation. Consumers are moving from a coverage-first mindset to a control-first mindset. They want to understand costs upfront. They want to choose where they go for treatment. They want the ability to pay in ways that fit their budgets. And when the value equation breaks, they’re willing to bypass the system entirely. 

THE CONSUMER HEALTHCARE MARKET WILL EXPAND 

If current trends hold, 2026 could mark one of the largest expansions of the uninsured and underinsured population in more than a decade. But instead of disengaging from the healthcare system, these consumers are building a parallel path through it. They are demanding the same things they expect from the best retail and digital experiences: clarity, predictability, immediacy, and trust. 

This creates a massive opportunity, and a significant responsibility, for the industry. Companies that can simplify access, make pricing transparent, and deliver affordable pathways to care will become essential partners. Those that cling to legacy models built around opaque reimbursement flows will watch consumers go elsewhere. 

We already see evidence of this shift. People are embracing subscription-based care for predictable costs, using telehealth for speed and convenience, and relying on platforms like GoodRx to access lower prescription prices. Services like my company GoodRx’s newly-launched telemedicine subscriptions for erectile dysfunction, hair loss, and weight loss are examples of how companies are meeting this demand, offering affordable, accessible healthcare options outside traditional insurance frameworks. 

WHAT HEALTHCARE LEADERS MUST DO NOW 

Healthcare has historically been built around the needs of institutions, not individuals. That era is ending. The organizations that thrive in the next phase will redesign around consumer agency and economic reality. 

Three shifts are essential: 

• Make cash pricing a standard, not a contingency. If people are paying out-of-pocket, they need to see the cost clearly, consistently, and upfront. Transparent pricing should be a baseline expectation across providers, pharmacies, and manufacturers. 

• Embed affordability into clinical decision making. Cost isn’t a “back office” issue. It should be integrated into prescribing tools, clinical workflows, and patient conversations. Providers need real-time insights into cash prices and savings options so they can help patients make informed choices before they reach the pharmacy counter. 

• Build care models that meet consumers where they are. Telehealth, retail clinics, asynchronous care, and hybrid models represent the way consumers want to access routine, preventive, and even chronic care. Healthcare companies must expand their presence in these channels or risk losing relevance. 

BUILD A CONSUMER-CENTRIC FUTURE  

The coverage squeeze is exposing something important: Consumers are demanding value, not just benefits. They want care that feels intuitive and affordable. They want to make decisions with clear information rather than insurance complexity. And they want healthcare that adapts to their lives. 

If we meet that demand, we have a chance to rebuild trust and deliver a healthcare experience that works for more people, regardless of their coverage status. If we don’t, consumers will continue to chart their own path, with or without the traditional system. 

The next chapter of American healthcare won’t be defined by the rise or fall of insurance premiums. It will be defined by whether we, as industry leaders, embrace a radically simple idea: When we design for the consumer first, everyone benefits. 

Wendy Barnes is president and CEO of GoodRx.