WASHINGTON (AP) — A different health care issue has emerged for Democrats, in sync with the party's pitch to workers and middle-class voters ahead of next year's elections.

It's not the uninsured, but rather the problem of high out-of-pocket costs for people already covered.

Democrats call it "underinsurance."

After paying premiums, many low- and middle-income patients still face high costs when trying to use their coverage. There's growing concern that the value of a health insurance card is being eaten away by rising deductibles, the amount of actual medical costs that patients pay each year before coverage kicks in.

"I think it's going to be the next big problem," said Rep. Jim McDermott, D-Wash., a congressional leader on health care.

"We've got some 17 million more people covered ... but they can't access the care they seem to be entitled to," McDermott said. "It costs too much to use the care. That's the deceptive part about it."

Since virtually all U.S. residents are now required to have health insurance by President Barack Obama's health care law, McDermott said Democrats have a responsibility to make sure coverage translates to meaningful benefits.

Several liberal-leaning organizations have recently focused on the issue.

—A Commonwealth Fund study found that 31 million adults were underinsured last year. Half of them had problems with medical bills or medical debt. Seven million were underinsured due to high deductibles alone. "The steady growth in the proliferation and size of deductibles threatens to increase underinsurance in the years ahead," the study concluded.

—A study by the advocacy group Families USA found that one-quarter of the people with individual health insurance policies went without care in 2014 because they could not afford the out-of-pocket costs. The study singled out high deductibles.

—The Center for American Progress, a think tank often aligned with the White House, found that employers have been shifting a disproportionate burden of health care costs onto workers. As a result, the report said, employees and their families have not shared in the benefits of a prolonged lull in medical inflation. The group recommended several policy changes, including rebates for workers under certain conditions.

"Cost shifting is part of what makes people underinsured," said Topher Spiro, vice president for health policy at the center. "There's an effort to raise the issue generally, and there's general recognition that this is a problem that needs to be addressed."

The insurance industry says the focus on deductibles and cost sharing is misplaced. It says the real problem is that the United States pays too much for medical care. Deductibles can be a legitimate tool for employers and insurers to steer patients to doctors and hospitals providing high-quality care at a reasonable cost. Some plans set lower amounts for services provided within a network.

"It can't be looked at in isolation," said Karen Ignagni, outgoing head of America's Health Insurance Plans, the main industry trade group.

Some consumers may prefer a high-deductible plan in exchange for lower monthly premiums, she added. "They are making a conscious decision to make that trade-off."

A wide body of research shows that out-of-pocket costs discourage people from getting medical care, but there is no agreed-upon standard of what constitutes "underinsurance."

The Commonwealth Fund, a private foundation that aims to improve the health care system, defines underinsurance as out-of-pocket costs that add up to 10 percent or more of household income, in most cases, or a deductible that amounts to 5 percent of income or higher.

Obama's Affordable Care Act set annual limits on out-of-pocket costs for most insurance plans, currently $6,600 for an individual policy and $13,200 for a family plan. It's better than no limit, but a stretch for many families.

Annual deductibles for employer plans averaged about $1,200 for employee-only coverage last year, according to the Kaiser Family Foundation.

Deductibles can be much higher for plans sold through the health law's insurance exchanges, averaging about $2,500 for single coverage under a midrange silver plan. But more than half of exchange customers receive additional government subsidies to reduce their cost sharing.

Democrats need an election-year health care narrative about how to improve Obama's law, said Robert Blendon, a professor at the Harvard T.H. Chan School of Public Health.

"The issue that has come up repeatedly is the impact that high deductibles are having on moderate income people," he said.

State Farm’s “Next Gen Good Neighbor” initiative delivers an unambiguous message to life and annuity distribution leaders: the future of distribution will be owned by human/artificial intelligence hybrids. Those that delay will watch a measurable efficiency gap become a permanent competitive disadvantage.

State Farm pairs AI tools — notably the Navi agent co-pilot and Household Story household intelligence platform — with sweeping changes to agent contracts, compensation structures, and performance expectations. The company explicitly bets that agents create the greatest value through relationship management and new-business growth, while AI handles administrative burden and delivers personalized insights at scale. This combination produces a clear mandate for the productive advisor of the future: relentlessly focused on acquisition, equipped with technology that enables previously impossible reach and precision.

Skeptics will emphasize that life and annuity distribution operates differently from personal-lines property/casualty distribution. Life and annuity sales depend almost entirely on advisors operating in career-agency and third-party distribution. But the impending advisor shortage highlights an unspoken truth: Advisor-led distribution will prove unsustainable and digital/AI hybridization is the only way to sustain long-term growth. The need for an advisor’s advice is not going anywhere, but the way in which it is delivered must change.

5 imperatives that define winning distribution models

Carriers that get this right will act decisively across five mutually reinforcing imperatives.

1. Govern AI with uncompromising rigor

Life and annuity carriers already operate under intense regulatory oversight. Adding AI to recommendations, advice and underwriting introduces new layers of scrutiny around transparency, data provenance, bias and suitability. Winners will embed compliance by design — requiring meaningful human oversight, audit trails, and clear accountability — rather than treating AI as a black-box productivity hack. They will position these systems as trust-enhancing tools that reinforce fiduciary standards, not undermine them.

2. Make hybrid human-plus-AI models table stakes for advisor effectiveness

Early adopters will enjoy a temporary productivity edge in new-business conversion, cross-sell and time-to-close. Tools that surface actionable insights, automate routine tasks, generate compliant recommendations and support real-time coaching will quickly move from differentiator to baseline expectation. Carriers that fail to deploy effective copilot capabilities will find their advisors falling behind more agile competitors on every key performance metric.

3. Reserve pure human advice for high-complexity, high-trust moments

Complex life insurance and annuity decisions involve long-term commitments, emotional weight, and nuanced suitability assessments where empathy and behavioral insight remain irreplaceable. Simpler products, by contrast, can migrate toward lower-friction hybrid or direct paths. The winning architecture offers clean, low-friction off-ramps from digital journeys to advisors precisely when human judgment adds the most value — lowering acquisition costs on straightforward cases without sacrificing relationship depth where it matters most.

4. Manage selective attrition and professionalization deliberately

State Farm’s emphasis on new-business generation and performance metrics will find parallels in life and annuity compensation redesigns. Agencies historically reliant on stable renewal income will face pressure. Forward-leaning carriers — especially those with captive or career-agency forces — will treat this transition as a deliberate capability upgrade: supporting consolidation where it strengthens the system, investing in AI-fluent advisor development and concentrating resources on high-potential producers. The result should be a smaller, more professional, higher-performing advisor population.

5. Realign compensation and recognition systems around growth, efficiency and outcomes

Many life and annuity carriers still lean heavily on production volume. The AI era demands metrics that capture true economic contribution: new premium, persistency, efficiency gains and — increasingly — effective use of AI tools. Progressive carriers will begin with positive incentives (qualification for recognition programs and incentive trips) tied to these outcomes before evolving minimum production thresholds or introducing variable elements linked to broader profitability and client results.

Execution realities

The transition will generate friction. Carriers should anticipate near-term impacts on advisor morale, temporary service-level pressure during rollout and the risk that some high performers explore the options of moving to a competitor or going independent. Capability gaps and implementation costs will vary significantly by organization scale.

Those that communicate with clarity, invest heavily in training and change management, and phase deployments thoughtfully will capture the long-term gains while minimizing unnecessary talent loss.

State Farm’s experience serves as a leading indicator, not a plug-and-play template. As the company detailed in its May announcement, the “Human + Digital” approach explicitly pairs technology investments with its agency model to let agents focus more time on growing relationships and acquiring new customers. The organizations that will win are those that define “good” explicitly across these five dimensions: rigorous AI governance, hybrid productivity as the operating standard, appropriate allocation of human judgment, proactive professionalization of the advisor force, and compensation systems aligned with growth and efficiency.

Distribution leaders should put three questions to their teams immediately: Where do we currently stand on the AI-adoption curve? What internal capabilities or external partnerships do we need to close any gaps? And how will we guarantee that AI strengthens — rather than erodes — the trust, judgment and relationship quality that have always defined successful life and annuity advice?

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