The 2026 Healthcare Cost Crisis - And Why Direct Care May Be the Answer You've Been Looking For: Insurance Cost Solutions

The 2026 Healthcare Cost Crisis

And Why Direct Care May Be the Answer You've Been Looking For

By Yoon Hang "John" Kim, MD, MPH

If you've started shopping for health insurance for 2026, you've likely experienced something that can only be described as sticker shock. For many Americans, particularly those on Affordable Care Act marketplace plans, this year marks a painful turning point. The numbers are stark, and they demand our attention—not just as patients and consumers, but as people who deserve better options for taking care of our health.

As a physician who has spent over twenty years in integrative medicine, I've watched healthcare costs steadily climb while the system becomes increasingly disconnected from what patients actually need. But 2026 feels different. This year, we're witnessing a perfect storm of expiring subsidies, rising premiums, and systemic inflation that's forcing many of us to rethink everything we thought we knew about accessing healthcare.

The 2026 Healthcare Cost Crisis - And Why Direct Care May Be the Answer You've Been Looking For: Insurance Cost Solutions

What's Driving the 2026 Cost Spike

The primary driver of this year's dramatic premium increases is the expiration of enhanced ACA premium tax credits on December 31, 2025. These temporary extra subsidies, which began in 2021, provided crucial financial relief to millions of marketplace enrollees. Without congressional action to extend them, that support has simply vanished.

But here's what makes 2026 particularly challenging: insurers have simultaneously raised their underlying premiums to account for higher medical costs, hospital expenses, prescription drug prices, and general inflation. So enrollees are getting hit from both directions—they're losing the subsidies that made coverage affordable while the base cost of that coverage climbs higher than ever.

The Numbers Tell a Sobering Story

According to the Kaiser Family Foundation (KFF), subsidized ACA marketplace enrollees will see their average annual premium payments rise approximately 114 percent in 2026. To put that in concrete terms, what cost roughly $888 in 2025 will jump to about $1,904—assuming enhanced credits are not renewed. That's not a typo. Premiums are more than doubling for many families.

Families USA reports that individual market premiums—including Obamacare and other non-group plans—will average about 26 percent higher in 2026 than the previous year, and that's before accounting for the loss of federal subsidies. When you layer the subsidy expiration on top of those rate increases, the impact becomes truly staggering.

Texas: Ground Zero for Premium Shock

Here in Texas, where I practice telemedicine serving patients in the San Antonio area and beyond, the situation is especially acute. Texas has one of the largest ACA enrollee populations in the country—approximately 3.9 million people—which means the premium jump and subsidy loss will hit an enormous number of residents.

Local reporting has documented dramatic cases, with some South Texas enrollees seeing their premiums rise more than twentyfold when enhanced credits end. A Houston-area analysis suggests that while Texans can expect significantly higher 2026 ACA premiums, some may be able to soften the blow by switching metal tiers, shopping across insurers, or exploring high-deductible plans compatible with Health Savings Accounts (HSAs).

But let me be honest with you: these are band-aids on a much larger wound. Switching to a bronze plan or raising your deductible might reduce your monthly premium, but it often means trading one form of financial anxiety for another—the fear that any significant health event could leave you facing thousands of dollars in out-of-pocket costs.

Employer Plans Aren't Immune

If you're fortunate enough to have employer-sponsored coverage, you might think you're insulated from these increases. Unfortunately, the data suggests otherwise. Mercer projects that employer health benefit costs will rise approximately 6.5 to 6.7 percent per employee in 2026—the steepest annual increase in roughly fifteen years. Average costs per worker are expected to surpass $18,500.

For small businesses and their employees, the outlook is even more challenging. National analyses show a median proposed premium increase of about 11 percent for small-group coverage in 2026, driven by rising medical and drug costs combined with a sicker risk pool.

What does this mean practically? It means higher payroll deductions, higher deductibles, narrower networks, and for many workers, the uncomfortable realization that "having insurance" doesn't necessarily mean being able to afford care.

Taking Finances Out of the Healing Equation

This brings me to a question I've been wrestling with for years: How can physicians and patients truly work together when finances constantly intrude on the healing relationship?

In traditional healthcare, every interaction becomes a transaction. You call with a question—that's a billable event. You need a form filled out—another charge. You want to discuss your lab results in depth—better make sure it fits in your allotted appointment time, or you'll see it reflected in your bill. This transactional model doesn't just frustrate patients; it fundamentally undermines the kind of relationship that produces real healing.

I know this intimately because I've lived it. In my previous integrative medicine practice, we billed cash for our services—what would be classified as cash fee-for-service. While I may have been serving my patients well in many ways, every time they engaged me, they got billed. We experimented with a membership model, but it never fully took off because we couldn't bring ourselves to completely abandon fee-for-service. We failed to take the plunge.

That experience taught me something valuable: half-measures don't work. You can't create a truly patient-centered practice while clinging to a billing model that inherently creates barriers between you and the people you're trying to help.

The Direct Care Revolution

So I studied the Direct Primary Care (DPC) model, and what I discovered surprised me. DPC is rapidly growing across the United States, offering an alternative that removes insurance companies from the primary care relationship entirely. When I left Kansas City about three years ago, a DPC practice had just opened. Today, it has several providers. That kind of growth speaks to a genuine hunger for something different.

The premise is elegantly simple: patients pay a monthly membership fee—often comparable to what you might spend on an upscale gym membership—and in return, they get direct access to their physician without the constant intrusion of billing, coding, and insurance negotiations. No copays for visits. No surprise bills. No wondering whether your question is "worth" a call to the doctor's office.

According to DPC Frontier, there are now over 2,800 direct primary care practices across all 50 states plus Washington, D.C., serving over a quarter million Americans. The Direct Primary Care Coalition reports that 34 states have enacted laws and regulations defining DPC as a medical service outside of state insurance regulations—a remarkable legislative momentum that reflects growing recognition of this model's value.

Building an Ecosystem of Direct Care

What excites me most about the direct care movement is that it extends far beyond primary care. An entire ecosystem is emerging that offers transparent, affordable pricing for services that have traditionally been shrouded in mystery and marked up beyond recognition.

Laboratory Testing: Many DPC practices offer deeply discounted labs—sometimes as low as $5 per test. Compare that to what you might pay through traditional insurance with high deductibles, and the savings become immediately apparent.

Imaging: Companies like Green Imaging (greenimaging.net) offer direct-pay MRIs, CT scans, ultrasounds, and other imaging services at a fraction of what hospitals typically charge. Their model purchases unused capacity at existing imaging centers and passes the savings along to patients—often 50 to 80 percent less than traditional out-of-pocket costs. A procedure that might cost $2,000 or more through the traditional system can often be obtained for a few hundred dollars.

Surgery: The Surgery Center of Oklahoma (surgerycenterok.com) has pioneered transparent, bundled pricing for procedures. They publish comprehensive, all-inclusive prices for every surgery online—something virtually unheard of in American healthcare. You know exactly what you'll pay before you walk through the door, and that price includes the facility fee, surgeon's fee, anesthesiologist's fee, and uncomplicated follow-up care. No surprise bills, ever.

Specialty Care: The Direct Specialty Care Alliance (dscalliance.org) is bringing the direct care model to specialists across the country—rheumatologists, cardiologists, endocrinologists, and others who are finding ways to practice outside the insurance system while providing accessible, affordable care.

Health Sharing: For catastrophic coverage and major medical events, health sharing organizations like Sedera (sedera.com) offer an alternative to traditional insurance. I've seen colleagues, their families, employees, and patients use these services with satisfaction. They're not insurance in the technical sense, but they provide a community-based approach to sharing medical costs that many find both affordable and aligned with their values. Members contribute monthly amounts, and when unexpected large medical expenses arise, the community shares those costs.

Direct Integrative Care: My Answer to the Crisis

Because I love integrative & functional medicine—and I view functional medicine as a specialization within integrative medicine that utilizes testing to explore potential root causes of illness—I wanted to create a sustainable model for those of us who believe in this approach to healing. Not just for the wealthy few who can afford boutique concierge practices, but for everyday people who deserve access to root-cause medicine.

That's why I created Direct Integrative Care. It's an environment where I can work together with patients for a monthly fee—probably similar to what you might pay for an upscale gym membership. In return, members receive 15 percent off supplements through Fullscript, access to wholesale-price functional medicine labs plus a modest 7 percent fee charged by our partner, and access to my professional services without the constant meter running on every interaction.

This isn't about cutting corners or providing less care. It's about removing the financial friction that prevents genuine healing relationships from forming. When a patient can message me with a question without worrying about whether they'll be billed for the privilege, we can have real conversations. When we're not constantly navigating insurance requirements, we can focus on what actually matters: understanding your unique situation and finding approaches that work for your body and your life.

A Different Way Forward

I won't pretend that direct care is a perfect solution for everyone. If you have a chronic condition requiring frequent hospitalizations, you'll still need some form of coverage for those major expenses. Health sharing organizations or a high-deductible catastrophic plan can fill that gap.

But for the day-to-day work of staying healthy, managing chronic conditions, and addressing health concerns before they become crises? Direct care offers something the traditional system simply cannot: a relationship with your physician that isn't mediated by billing codes and insurance company gatekeepers.

As you navigate the difficult decisions ahead regarding your 2026 coverage, I encourage you to think beyond the traditional options. The direct care movement is growing because it works—for patients who want genuine relationships with their healthcare providers, and for physicians who went into medicine to heal people, not to spend their days fighting with insurance companies.

The 2026 healthcare cost crisis is real, and for many families, it will be painful. But within that crisis lies an opportunity to ask bigger questions about what we really want from our healthcare system—and to discover alternatives that may serve us far better than the broken model we've been handed.

The 2026 Healthcare Cost Crisis - And Why Direct Care May Be the Answer You've Been Looking For: Insurance Cost Solutions

References and Resources

Data Sources

Kaiser Family Foundation (KFF): Comprehensive health policy research and data on ACA marketplace trends. kff.org

Families USA: Consumer health advocacy organization providing analysis of premium trends. familiesusa.org

Mercer: Employer health benefit cost projections and workforce consulting. mercer.com

Direct Primary Care Organizations

DPC Frontier: Find a DPC practice near you with their interactive mapper featuring over 2,800 practices across all 50 states. dpcfrontier.com

Direct Primary Care Alliance (DPCA): Physician-led organization providing education, mentorship, and advocacy for the DPC community. dpcalliance.org

Direct Primary Care Coalition (DPCC): Advocacy organization supporting state, federal, and private sector policies that advance DPC. dpcare.org

Direct Specialty Care

Direct Specialty Care Alliance (DSC Alliance): Organization leading the movement of specialist physicians in providing direct care services. Founded by Dr. Diana Girnita, featuring a directory of direct care specialists. dscalliance.org

Transparent Pricing Services

Surgery Center of Oklahoma: Pioneer in transparent, all-inclusive surgical pricing. Complete prices published online for every procedure including surgeon, anesthesia, facility, and follow-up care. surgerycenterok.com

Green Imaging: Affordable direct-pay MRIs, CT scans, ultrasounds, mammograms, and other imaging services. Network of 4,500+ facilities nationwide with savings of 50-80% compared to traditional pricing. greenimaging.net

Health Sharing Communities

Sedera: Medical cost sharing community founded in 2014 in Austin, Texas. Members share large and unexpected medical expenses through voluntary monthly contributions. No religious requirement for membership. sedera.com

Direct Integrative Care

Direct Integrative Care: Membership-based integrative & functional medicine practice founded by Dr. Yoon Hang "John" Kim, offering telemedicine services across multiple states with wholesale lab pricing and supplement discounts. directintegrativecare.com

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Dr. Yoon Hang "John" Kim is a board-certified integrative medicine physician with over 20 years of clinical experience. He completed his integrative medicine fellowship at the University of Arizona under Dr. Andrew Weil and founded Direct Integrative Care to provide accessible, membership-based integrative medicine through telemedicine. Dr. Kim is the author of three books and maintains an active educational presence through his YouTube channel and the LDN Support Group, which he founded and moderates for over 7,000 members.