Background: The United States spends 18% of gross domestic product, the largest proportion globally, on healthcare. American healthcare administration costs two to five times more than other high-income nations, which is transferred to the public as health insurance premium price difference. Improved healthcare access is an underlying tenet of the Affordable Care Act (ACA), however inflated health insurance premiums could reduce healthcare access.
Methods: This review is based on Google, Google scholar, and PubMed literature searches performed in February 2016, to analyze rising health insurance premiums as an area for health system reform within the context of the current health system. Subsequent literature search in October 2016, confirmed the original analysis.
Results and Conclusions: Except for those whose income is less than 176% of the federal poverty level selecting the minimum premium bronze plan, despite subsidies, post-ACA premiums are greater than previous out-of-pocket costs for the insured. Excessive healthcare insurance premium prices decrease healthcare access. Implementation of zero profit margins for health insurers, maximum 14% health insurer administrative cost, and universal health insurer eligibility for reinsurance, universal health insurance annual loss ratio requirements, Medicare and Medicaid prescription drug price control, and universal clearinghouse strategy health exchanges should reduce healthcare insurance premium prices. The net effect should be improved healthcare access for all Americans, not just Americans living at 175% or less of the federal poverty level. The unchanged 62% medical bankruptcy rate in 2007 and 2015 may reflect overall unimproved financial security and healthcare accessibility provided by the ACA.