Millions of Americans face big jump in health care costs

Tens of millions of Americans who receive coverage through health insurance marketplaces could see a big jump in costs next year.

Notices filed by more than 100 companies that offer insurance through the marketplaces show there could be a median 15% increase in premiums in 2026, according to findings from the Peterson-KFF Health System Tracker.

The increase would represent the largest jump in premiums since 2018, when the reinstatement of a federal health insurance tax drove up U.S. health spending. Insurers cite rising health care costs, tariffs and other policy changes as contributors to the forthcoming increases.

Marketplace consumers may also receive another hit to their wallets thanks to the planned expiration of enhanced premium tax credits at the end of 2025. Scrapping the credits, which save marketplace users an average of about $700 a year, could cause more than 4.2 million people to become uninsured by 2034, the Congressional Budget Office has projected.

The federal and state health insurance marketplaces, authorized under the Affordable Care Act, were created to provide lower-cost, more robust health insurance coverage options for Americans. Companies that sell insurance through the marketplaces are required to cover essential and preventive health care without lifetime limits and cannot deny coverage based on pre-existing conditions.

More than 24 million people chose health insurance coverage through health insurance marketplaces during the 2025 enrollment period, according to the Centers for Medicare & Medicaid Services. Nearly 17 million of them enrolled through the federal marketplace, while the remainder signed up through state marketplaces. About 3 million people participated in marketplaces for the first time this year.

Enrollment through ACA marketplaces has more than doubled in 20 states since 2020, with tripling of enrollment in Georgia, Louisiana, Mississippi, Tennessee, Texas and West Virginia, other research from KFF has found. Four of those states — Georgia, Mississippi, Tennessee, Texas — have failed to expand Medicaid eligibility for low-income residents and already have some of the nation’s highest rates of uninsurance, according to America’s Health Rankings.

PFAS exposure may raise risks for diabetes

People exposed to “forever chemicals” may be at higher risk of developing Type 2 diabetes, new research finds.

Published July 21 in eBioMedicine, the study found that people with higher levels of per- and polyfluoroalkyl substances in their blood samples had a significantly greater risk of developing Type 2 diabetes during their lives. The chances of developing Type 2 diabetes increased by 31% each time PFAS levels rose a third higher, researchers found.

PFAS are used in a range of consumer products, such as nonstick cookware, stain-resistant furniture and waterproof clothing. Linked to health issues such as cancer and increased cholesterol, PFAS are known as forever chemicals because they don’t break down in the environment or human body. Some types of PFAS that were phased out years ago are still detected in drinking water, soil and even crops.

PFAS are endocrine-disrupting chemicals, meaning they can interfere with hormones such as estrogen, testosterone and thyroid hormones. Study researchers said PFAS may raise risks for diabetes by impairing the work of amino acids, some of which play a role in regulating insulin and blood sugar.

About 36 million U.S. adults have Type 2 diabetes, rates of which have increased significantly in recent decades. 

More primary care doctors opting not to take Medicare

Medicare users may have a harder time finding a primary care doctor, as a greater share of them are opting to withdraw from the federal health insurance program.

While the percentage of doctors in the U.S. who take Medicare has been decreasing for some time, the share of physicians exiting the program each year has increased more significantly recently, according to a new study in JAMA Health Forum. Overall, about 3.6% of U.S. physicians left Medicare in 2024, compared to 1.8% in 2010.

Primary care doctors, who are already in short supply in the U.S. medical workforce, were most likely to stop participating in Medicare, exiting the program at a rate of 4.4% in 2023. Researchers suggested growing demands for clinical documentation, more work from electronic communications and decreased payments may be contributing to the growing exodus. Other research has found higher burnout rates among primary care physicians.

The U.S. is already facing a worsening shortage of primary care doctors, particularly in rural and underserved areas. By 2037, the nation is expected to have a shortage of more than 87,000 such workers, according to the Health Resources and Services Administration. Primary care physicians include family medicine physicians, general internal medicine physicians, pediatricians and geriatricians.

Other recent public health news of note includes:

• The closure of a coal-fired power plant in Pennsylvania led to near-immediate improvements in respiratory health among area residents, new research in the American Journal of Respiratory and Critical Care Medicine finds. Just weeks after the Shenango coke works plant closed in January 2016, respiratory-related emergency visits fell by about 20%, researchers found. In the first month post-closure, child asthma visits dropped by 41%.

• Most U.S. states aren’t doing enough to reduce plastic pollution, according to a new report from the Ocean Conservancy. The organization graded states on actions such as banning single-use plastic, preventing microplastic contamination and supporting recycling, awarding a grade of “needs improvement” to 44 states. California earned the report’s highest rating, while Mississippi received the lowest.

• Nearly 123 million people around the globe live in areas that are at elevated risk for diseases that are passed from animals to humans, new research in Science Advances says. Published July 23, the study found that 3% of the world’s population lives in places at extreme risk for outbreaks of zoonotic diseases, while 20% live in areas at medium risk of outbreaks. About 60% of infectious diseases that impact humans are zoonotic, including Ebola, mpox and rabies.

• New research in JAMA Internal Medicine finds people who reside in neighborhoods with high incarceration rates live shorter lives, even if they’ve never been incarcerated themselves. About 113 million people in the U.S. have had a family member incarcerated, which can lead to stress and financial struggles and weaken the sense of community in a neighborhood. 

• Infant death rates are higher in U.S. rural areas than urban ones, a new data brief from the National Center for Health Statistics reports. From 2021 to 2023, infant mortality rates were 27% higher in rural counties than large metropolitan counties. Small and medium metropolitan counties experienced death rates that were 20% higher than large ones.

• Pesticides that are used to protect seeds from insects are contaminating U.S. water sources, according to new findings from the Natural Resources Defense Council. Researchers detected concentrations of neonicotinoid pesticides, also known as neonics, in Colorado water at 100 times the level known to harm aquatic life. Conventional treatment is ineffective at removing neonics from drinking water.

The Watch is written by Michele Late, who has more than two decades of experience as a public health journalist.