9 in 10 voters say healthcare costs will influence their electoral vote. It is the #1 issue, tied with gas prices.
Three forces shaping the debate.
- Coverage shock. ACA Marketplace premiums roughly doubled (+114%), and more than 1 million fewer people enrolled this year.
- Medicaid cuts. ~$1 trillion in budget reductions and stricter work requirements could mean up to 5 million people lose coverage.
- Thinner coverage. Employers are passing more of the bill to employees and limiting provider networks to manage their own costs. Having insurance no longer guarantees affordable care.
Both parties are campaigning on healthcare affordability.
But their solutions look vastly different, and many put hospitals in the frame: payment cuts, price transparency enforcement, scrutiny of consolidation. Taking a side risks alienating the other, especially in purple states, so most health systems choose silence. The problem: voters are actively looking for someone credible on affordability, and no one is better positioned to be that voice than health systems.
What this means for your system
The impact is already on your income statement. The patients change.
People without coverage defer care, then show up in the ER when they are sicker and more costly to care for. Even patients who have coverage are shopping on price in addition to quality, convenience and relationships. Transparency rules created comparison behavior. Coverage loss is reshaping how, where, and whether people seek care.
$32B projected lost provider revenue in 2026 from subsidy expiration alone.
$7.7B projected increase in uncompensated care this year as the uninsured default to the ER.
Scrutiny of hospitals’ role in the affordability crisis is growing, and it’s bipartisan.
Transparency warning letters. Site-neutral expansion. 340B reform. Consolidation hearings. AI oversight. Five fronts, one theme: prove your value or have it questioned for you.
These pressures have outgrown departmental siloes. The systems that succeed will treat affordability as an enterprise strategy, not a departmental initiative.
Why this can’t wait until Q4
The clock is running.
- Now — Healthcare affordability confirmed as the #1 voter issue.
- Now — New Medicaid work-rule notices are hitting mailboxes. Patients want someone to explain how to navigate it.
- Aug. 1 — Proposed 2027 ACA premiums went public. When increases hit, hospitals got blamed.
- Aug. 31 — Comment deadlines close on CMS’s proposed payment cuts.
- September — The campaign ad flood begins. $11.6B projected, the most expensive midterm cycle in history.
- Nov. 1 — Marketplace open enrollment. Cost, access, and coverage shape the conversations happening, and whose to blame.
Affordability is defining the healthcare debate. The question is whether your organization shapes the conversation or spends months defending itself.
The BPD Healthcare Perspective
Silence on affordability is an enterprise risk.
The question every stakeholder is about to ask: what are you doing to make healthcare more affordable? Don’t let someone else answer it for you.
Hospitals have permission to lead.
Hospitals are far more trusted by consumers than insurers, drug manufacturers, and government. Consumers say they want information and help understanding costs, and they reward systems that help them better understand and better navigate their care.
Three questions for your leadership table:
- Exposure. Which affordability pressures are hitting your margin, payer mix, and volume hardest, and have you put a number on them?
- Proof. What is your system doing today to help patients navigate cost and coverage, and can you prove it in simple terms a patient, an employer, or a payer would believe?
- Readiness. When a reporter, a board member, or a negotiating counterparty asks what you’re doing about affordability, who answers, and with what?
Where BPD comes in.
BPD Healthcare works with health systems nationwide to size affordability exposure, build a value story that holds up with patients, employers, and payers, and get it in market before the environment defines it for you. If any of the three questions above is hard to answer, that’s the conversation to have now.
