How we can make health care more affordable in the U.S.

Jan 29, 2026 by AFP

Americans feel the effects of rising health care costs every month.

From rising premiums to higher prescription prices, even with insurance, many families have to make trade-offs when it comes to their health and well-being.

Half of Americans find it difficult to afford health care. One in four say they or a family member had problems paying for health care in the past year. A similar number said they had to put off needed care.

As federal mandates, bloated and fraud-prone subsidies, and restrictions on out-of-state care drive prices up, you may be asking: How do we make health care more affordable?

The good news is that we don’t need more government spending to make health care affordable. We need to end failed policies, remove government barriers, and expand proven options that put patients back in control.

Stop repeating the Affordable Care Act’s failures

Any serious effort to lower health care costs must start with preventing the temporary Covid-era ACA subsidies from coming back.

And to be clear, ending these inflated subsidies just means we’ve gone back to the still-generous subsidy levels that existed in 2021, with subsidies covering about 80% of the cost. To hear the Democrats tell it, that is a catastrophe, which tells you all you need to know about what they really think of the program they’ve lauded for the past 15 years.

These expensive subsidies were expanded during Covid to broaden access to health care. The catch is that the program became rife with fraud, resulting in millions being enrolled who likely didn’t even know they were covered! The result has been runaway costs and tens of billions going to insurance companies to pad their profits.

By making insurance free or nearly free for millions of people, Washington removed pressure on insurance companies to compete on price or value, as they were guaranteed federal subsidies to cover high costs.

The result was predictable:

Higher premiums
Massive taxpayer spending
Billions in profits for big insurance companies

Allowing these inflated Covid subsidies to expire was a crucial step in reducing health care costs.

However, we must continue to pressure Washington, as some misguided lawmakers are still trying to bring them back. Restarting the costly subsidy expansions would only continue the cycle of rising prices and increased government spending.

Remove regulations that block competition

Health care costs stay high when competition is limited — and government red tape is typically the reason.

In many states, certificate-of-need laws require government approval before a new clinic, hospital, or imaging center can open. These laws protect established providers from competition and prevent lower-cost alternatives from entering the market.

Other barriers, like limits on insurance options, restrictions on out-of-state care, and weak price transparency, add to the problem.

Lowering costs means cutting red tape and letting providers compete for business. When competition increases, prices fall, and patients reap the benefits.

Expand health savings accounts

One of the most effective ways to lower health care costs is to let patients control their own health care purchases.

HSAs do exactly that.

They allow individuals to save and spend money, tax-free, on qualified medical expenses. When people use their own money, they shop for value, ask questions, and compare prices. Providers respond to these market signals by lowering costs and being up-front about pricing.

But the HSA system is chronically underutilized.

Expanding access is crucial, and can include:

Allowing more Americans to have an HSA, regardless of what insurance they use
Expanding the menu of eligible expenses
Raising annual contribution limits
Converting subsidies like Obamacare into cash deposits to HSAs

Making these changes would empower families to make choices while encouraging smart spending and driving costs down.

Increase access to direct primary care

Direct primary care is another powerful solution for reducing medical costs.

With DPC, patients pay doctors directly through a monthly subscription — typically $100 to $150 — for primary care services, often with nearly unlimited visits.

Even specialty visits are typically discounted, as DPC practices often have established relationships with specialists in their area.

There are no insurance middlemen, no surprise bills, and no hidden prices.

Patients get better access and a personal relationship with their doctor. Physicians spend less time on paperwork and more time providing care.

A provision of President Trump’s recently enacted Working Families Tax Cuts allows tax-exempt HSA dollars to be used for DPC services, which is major progress.

Now, policymakers should build on this success by allowing people to use their HSA for direct access to specialists, not just primary care doctors. Cancer doctors. Diabetes doctors. Cardiac doctors.

The Personal Option: A real path forward

Rather than increasing government spending or adding regulatory burdens on hardworking Americans — or, goodness, looking to Washington for solutions! — AFP’s Personal Option health care agenda would fund patients, not insurance companies, and remove needless barriers between patients and the care they need.

We know lower costs don’t come from bigger bureaucracy. They come from trusting families to make decisions for themselves.