Ever Climbing: Rising health insurance costs concern SM East families and experts

When sophomore Hampton Boyd broke both his right forearm bones playing lacrosse two years ago, the process was straightforward: a cast and a few doctor visits.

But it cost $8,000. Health insurance only covered $1,500.

Healthcare is expensive, and the costs of buying health insurance go up yearly. Costs are set to nearly double for many families next year, which has also been the reason for the government shutdown. The estimated cost of healthcare will increase by more than 9% in 2026 — making it the highest jump in a decade, according to the New York Times. On top of this, the cost of some 2026 health insurance plans will increase by an average 30% and could reach up to 114%, according to KFF.

With families signing up for their 2026 health insurance plan in November and December, higher health insurance costs are forcing SM East families, some of whom own small businesses, to navigate the balance between how much they’ll need to spend on health insurance and the benefits it offers.

“Most high school students don't think about [health insurance],” said Rick Boyd, Hampton’s father and a benefits consultant for an insurance broker. “I would say that's true for most college students and most adults in their 20s.” 

High school students can be on their parents’ health insurance plan until age 26; however, as health insurance costs go up, families have less spending money — the money that parents spend on their children for college visits or to buy a car, according to SM East nurse Stephanie Ptacek.

SM East parent Susan Neuman’s monthly health insurance costs could double or triple next year. And if she can’t afford a “good” health insurance plan, she may not have coverage for her $75,000 surgery. 

Neuman and her husband run their own freelance advertising businesses. Like many other small business owners, their family receives health insurance through the Affordable Care Act (ACA) — a website where individuals and families can compare and purchase health insurance plans. 

The ACA was established in 2010 to decrease the number of uninsured Americans, according to KFF. In 2021, the government provided financial support — in the form of ACA subsidies. The subsidies decreased the monthly costs of health insurance and increased access to healthcare for Americans.

Congress extended the subsidies until the end of 2025, but if Congress doesn’t extend them for 2026, they’ll expire, according to KFF. With the expiration of subsidies, the amount ACA clients will pay for insurance coverage increases by an average of 75% next year, according to Health System Tracker.

“There are more than 24 million Americans who receive their health insurance through ACA,” said Kelly Cannon, director of corporate communications for Blue Cross Blue Shield of Kansas City. “If the [subsidies] expire, many of these people could be left without health insurance and unable to afford care.” 

Democrats are pushing for action on the subsidies, while Republicans have said they won’t discuss policy changes until the government reopens, according to the Associated Press. The standoff has resulted in the longest government shutdown in U.S. history, according to CNN.

Neuman’s family enrolled in an ACA plan last year, called Aetna, because it was $700 cheaper than their previous coverage due to the subsidies. 

“We can't keep this coverage next year because [Aetna has] already told us that they're not participating in the ACA anymore,” Neuman said. “So now we're gonna have to go back to square one and try to figure it out, but we don't know yet what our options will be.”

According to Ptacek, the loss of subsidies could lead to more emergency room visits. 

“If the price of insurance is too high and people forego insurance, they won't have primary care access,” Ptacek said. “So, they'll seek healthcare through emergency services, which really bogs down the system. It makes it harder for real emergencies to access care.”

Additionally, the loss of subsidies would result in prescriptions for chronic conditions and a lack of timely preventive care and treatments, according to Cannon. These trends could further drive up overall healthcare costs and increase the number of preventable diseases and deaths.

Elizabeth Haire, a social worker at the University of Kansas Medical Center, shares Cannon’s concerns. As part of her job, Haire helps patients navigate their health coverage options and prescriptions, including patients with insurance through the ACA. 

“I'm really afraid of what's going to happen,” Haire said. “If the subsidies expire and the ACA isn’t an affordable option anymore, a lot of patients will be affected. Aside from pointing them to the limited resources that exist in the community, I'm not sure what we’ll do.”

Junior Bella Tilgner is enrolled in a medical science class and has taken Financial Literacy and Exploring Medical Health Careers classes in past years. 

“[Health] insurance, overall, is talked about within those classes, but I don’t know the details,” Tilgner said. “[Health insurance] is huge in the real world, and there's so little knowledge of it when you're in high school. It needs to be talked about more before high schoolers enter college or the workforce.”

The younger population should understand that healthcare is preventative, but critical for serious health problems, according to Boyd. Cancer diagnoses, car wrecks and sports injuries are unpredictable.

“A lot of people don't feel like they need health insurance until they need it, and it's too late,” Boyd said. “I mean, you can't buy homeowners' insurance when your house is on fire. You've got to get it ahead of time.”

SM East parent Leslie Darrington’s 8-year-old son was diagnosed with Type 1 diabetes last year. Type 1 is an autoimmune disorder; there was nothing specific that caused it, and there’s nothing to prevent it.

Darrington gets her family’s health insurance through her husband’s job; however, her three business partners get health insurance through Darrington’s small business. Small businesses don’t have the negotiating power of large corporations, requiring them to pay higher monthly costs for health insurance.

“[Health insurance] is one of the benefits that we offer, and it's really important to us,” Darrington said. “We'll just pay [the higher costs]. We'll have less profits, but we're not gonna take health insurance away from people. We just have to eat that additional cost.”

Despite healthcare costs being high, health insurance doesn’t cover many expenses for Darrington’s son. His healthcare costs are around $10,000 yearly. Half of that isn’t covered by insurance.

Darrington pays for the patches for her son’s devices, alcohol wipes, blood sugar test strips and an insulin pump. Her insurance through her husband’s job covered $4,000 of the $5,000 pump, but if Darrington were on her small business plan, she’d have to pay the full $5,000.

Additionally, Darrington’s son needs multiple glucose monitoring patches a month. The patches are supposed to last 10 days, so insurance covers the cost of three patches monthly. But Darrington’s son's skin reacts differently, and the patches don’t last as long. Despite the doctor prescribing more patches for Darrington’s son, the insurance company denied covering them, resulting in $100 out-of-pocket costs.

Darrington has had to pay the $100 “more times than she can count.”

“I think that health coverage should be determined by the doctor,” Darrington said. “Why does insurance get to have the final say when the doctor is the one with the medical degree? The insurance company is able to tell you what you can do, even though you have a doctor saying this is what you need to live.”

According to Boyd, healthcare costs are rising because medications are getting more expensive and large healthcare systems are taking over. Newer, expensive drugs for weight loss, like Wegovy and Ozempic, are in high demand, raising overall prices. 

Insurance companies pay hospitals to provide healthcare services. As healthcare costs rise, hospitals push insurance companies to pay more so they can cover their growing expenses. Because of their size, large healthcare systems have the power to negotiate higher payments from the insurance companies.

“For example, if KU says they want an 8% increase [in payments], the insurance company can say, ‘No, we're not going to take it,’” Boyd said. “Then KU leaves their network, and [the insurance company] can't stand it, so they cave, and they give them a 6-7% increase.”

Year after year, these increases compound.

“The next thing you know, your [healthcare] costs have doubled in 10 years,” Boyd said.

Additionally, health insurance is tied to jobs. Big corporations can negotiate lower health insurance prices, while smaller businesses have less affordable options, according to Neuman.

Neuman and her husband decided that they weren’t going to base their jobs on access to health insurance. However, according to Neuman, the vast majority of people believe the biggest reason to work for a larger business is to get better health benefits.

“I started my own business, and I'm creating an opportunity for myself and not taking a job that someone else can have in some big corporation,” Neuman said. “But it still feels like I’m being penalized by the options that are available for healthcare.”

The difference in cost between buying insurance independently versus getting it through an employer means students need to consider health insurance while planning for their future career options, according to Ptacek.

“Every single one of us is going to need healthcare at some point in the future,” Haire said. “It’s so important that as a society, people have continued access to preventative care and medical maintenance.”