Healthcare costs are a major area of financial strain for Americans. A new report from Georgetown University’s Center on Health Insurance Reforms provides recommendations for lowering health insurance costs and making insurance easier to use.
The report was supported by the Robert Wood Johnson Foundation, a national philanthropy focused on healthcare. It explains that health plans have shifted rising provider costs onto families through higher deductibles and stricter prior authorization, while vertical integration and private equity have also driven up healthcare costs.
The federal policy recommendations include:
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1. Reducing healthcare costs: The report recommends capping out-of-pocket costs, noting that in 2026, maximum out-of-pocket limits are $10,600 for individuals and $21,200 for families. Single deductibles are $1,886 in employer plans on average and over $3,700 in the ACA Marketplaces. CHIR suggests capping annual deductibles at $1,000 for individuals and $2,000 for families, and limiting maximum out-of-pocket limits at $4,000 for individuals and $8,000 for families.
It also notes that capping commercial hospital prices at 200% of Medicare rates could save employers and consumers $88 billion a year in premiums and $10 billion a year in out-of-pocket costs. In addition, CHIR recommends eliminating copays and deductibles for some primary care, mental health and chronic disease services.
2. Reducing unnecessary complexity: The report suggests making prior authorization decisions more efficient and consistent, including requiring automated prior authorization workflows and standard decision time limits.
CHIR also recommends extending the ACA’s Essential Health Benefits standard to large-group and self-funded employer plans. The standard outlines specific healthcare service categories that most individual and small-group health plans must cover.
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3. Protecting patients from corporate abuses: CHIR calls for reforming the No Surprises Act, specifically its independent dispute resolution process, which is used to resolve out-of-network payment disputes between payers and providers. The organization argues that private equity-backed groups have abused the process.
In addition, the report recommends reining in private equity business practices and reducing medical debt by creating a new fair billing certification program for hospitals. The program would require free or discounted care for low-income patients and presumptive financial assistance screening.
“People are paying dramatically more for health insurance but still find that their coverage is difficult and expensive to use,” said Sabrina Corlette, co-director of CHIR at Georgetown University’s McCourt School of Public Policy, in a statement. “Policymakers do not need to start from scratch to make meaningful progress. By pairing direct relief for consumers with policies that address excessive prices, policymakers can make insurance work much better for families and employers.”
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