Can’t Pay Medical Bills? Trump Officials Suggest Getting a Loan. (June 11, 2026 )
June 11, 2026 — Buried in a 1,121-page Centers for Medicare and Medicaid Services final rule governing Affordable Care Act marketplace operations for 2027, the Trump administration floated a striking proposal: that insurers consider offering loans to enrollees who cannot afford their out-of-pocket costs — debt to be repaid, presumably with interest.
The suggestion lands in the context of a crisis already in progress. ACA premiums surged after Congress ended the enhanced federal tax credits last year. Average monthly premiums rose from $113 in 2025 to $178 in 2026, while the average annual deductible now stands at nearly $4,000 per person, according to KFF. Roughly 40 percent of marketplace enrollees are in Bronze plans with out-of-pocket maximums exceeding $10,000 for an individual. More than one-third of American households already carry medical debt.
The same rule expands eligibility for bare-bones catastrophic plans — which cover major illness but not routine care — beginning in 2027. By 2028, a family could enroll in a catastrophic plan with a deductible exceeding $31,000. Lawsuits filed by cities and health organizations, which have already blocked portions of this year's ACA rules, now challenge these provisions as well. Plaintiffs contend the changes will cause at least three million Americans to lose marketplace coverage in 2026 alone.
Critics were blunt. Stanford economist Neale Mahoney called the loan idea "hugely out of touch with where people are." Dr. John W. Scott of the University of Washington, whose research found high-deductible patients delay emergency care until their conditions worsen, described insurer lending as "a restructuring of who they owe the debt to — and that is the opposite of a solution." Johns Hopkins researcher Catherine Ettman noted that Americans with medical debt consistently forgo not just medical care but dental and mental health care as well.
UnitedHealth Group, which already operates a bank through its Optum unit, is technically positioned to offer such loans. The company declined to comment. The insurance industry trade group AHIP offered only that insurers "are always evaluating other innovative ways to promote affordability."
| https://www.nytimes.com/2026/06/11/business/aca-health-care-costs-medical-debt.html |