AHIP: 'NOTHING MORE IMPORTANT' THAN HELPING AMERICANS ACCESS AFFORDABLE CARE

The following information was released by the America's Health Insurance Plans (AHIP):

Health plans are doing everything in their power to shield Americans from the high and rising costs of medical care. Data show that in 2024 health plans' profit margin was 0.8%, and that in 2023 health plan profits represented about 0.5% of national health expenditures. Health plans are the only part of the health care system whose profits and administrative costs are capped under federal law.

Nothing is more important than helping Americans access the care they need at prices they can afford including the 24 million Americans who count on affordable coverage in the individual market and are facing soaring costs in 2026 unless action is taken soon.

We continue to support bipartisan solutions to lower costs for everyone.

Mike Tuffin, President & CEO, AHIP

Key Facts & Resources:

Health plans' profit margin was 0.8% last year, 2024 NAIC data show. In 2023, the net income of health plans accounted for about 0.5% of U.S. health expenditures ($4.9 trillion, per CMS data).

Health plans are the only part of the health care system whose profits and administrative costs are capped under federal law. Health insurers must spend at least 85% of group premiums and 80% of individual premiums on medical care. If those thresholds are not met, health insurers must pay rebates to consumers. Since 2012, consumers have received nearly $12 billion back from insurers, with more than $1 billion in 2024 alone, according to KFF.

Health insurance premiums reflect the underlying cost of health care. Learn more about where Americans' health care dollars go (infographic) and the factors influencing 2026 individual market premiums.

Numerous health policy experts have debunked the false narrative of so-called phantom patients in the individual market. Policymakers have taken decisive action to prevent fraud in the marketplace, including significant policies enacted through the One Big Beautiful Bill Act and the Marketplace Integrity and Affordability rule. 

24 million Americans who obtain coverage through the individual market face an acute cost-of-living crisis. The Washington Post reports that millions of lower- and middle-income Americans will see their health insurance payments double or even triple in 2026 if Congress lets the health care tax credits expire. Data released by the Joint Committee on Taxation confirm that 95 percent of tax credits go to households earning under $200,000, with most benefiting families earning less than $80,000.

Polls from leading Republican, Democratic and nonpartisan researchers show American voters overwhelmingly support continuing the tax credits. The issue is set to play a significant role in how millions of Americans vote in the 2026 midterm election. 

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