Healthcare workers see rising insurance costs

BOISE, Idaho — Joshua and Ashley Durham run a family medicine practice, and for the first time in their lives, they have no health insurance.

When the Durhams began their practice at the end of 2023 — he as a primary care physician and she as a pharmacist who handles the billing — the couple bought coverage for themselves and their two kids on the Affordable Care Act marketplace.

This year, they said their monthly premiums for a similar health plan rose several hundred dollars to almost $1,600.

They decided to pay out of pocket for their medical expenses instead, leaning on $50,000 they set aside in a health savings account over several years.

"It's nerve-racking," said Joshua Durham, 47. "It just takes, you know, one little accident, and then you got a big fat bill."

The healthcare industry traditionally has more of its workforce on medical insurance than many other fields. Nationwide, 7% of all healthcare workers were uninsured in 2024, compared with 11% of all adults under 65, according to a KFF analysis of the most recent American Community Survey data. Doctors were especially unlikely to forgo health insurance, with just 2% uninsured.

Now, even healthcare workers feel the pinch as health insurance costs rise; employers expect costs to jump an additional 8.2% for 2027.

The Republican-led Congress also opted last year not to renew Affordable Care Act marketplace credits enacted during the COVID19 pandemic. While subsidies remain in place for people with low incomes, the pandemic-era credits helped reduce many consumers' premium payments, especially those working in small businesses such as independent medical practices. Almost half of marketplace enrollees worked for small businesses or were self-employed in 2024; some of the most common occupations included chiropractic care and dentistry.

Jack Dillon, executive director of the Association for Independent Medicine, which represents 4,000 physician-led practices, said premium increases became untenable for small businesses, whether employers seek coverage through the marketplace or directly from insurers.

As health insurance continues to become less affordable, Dillon said, more healthcare employers may seek alternatives to their standard coverage, such as providing higher hourly wages or providing only minimal plans.

The number of people without insurance in the U.S. is expected to increase by about 15 million over 10 years because of the expiration of the expanded ACA subsidies and $1.1 trillion in estimated cuts resulting from President Donald Trump's signature One Big Beautiful Bill Act, according to the Congressional Budget Office.

Healthier people are the most likely to opt out of insurance. That leaves insurance covering a smaller pool of people who tend to be sicker and need more expensive care. So insurers raise prices to cover the remaining enrollees, which fuels even higher premium costs.

Samantha LeGault, a nurse practitioner at a health clinic in Boise, said her employer-offered plan's premium payment rose from $700 to $1,500 a month this year to insure herself, her husband and four of their kids. LeGault has Crohn's disease and two of their daughters also have medical conditions, so she said her family has no choice but to continue to pay for that health coverage.

She decided to skip dental insurance to save money, and she prioritizes dental visits for her children over herself.

The Durhams have three other employees in their practice. Two receive health insurance through their spouses, Ashley Durham said. The Durhams said they pay $420 monthly toward their physician assistant's premiums.

As a primary care physician, Joshua Durham said he doesn't need regular doctor visits, because he can diagnose and treat himself — and, if needed, the rest of his family, though he acknowledged that's frowned upon. The American Medical Association's code of ethics generally discourages doctors from treating themselves or relatives but makes exceptions for emergency situations or shortterm, minor problems. Ashley Durham said she's filled prescriptions for her family.

Arthur Caplan, a bioethicist and professor emeritus at New York University's Grossman School of Medicine, said that as more people are "turning toward relatives because they can't access or easily see a regular doctor," it may make sense to revisit that aspect of the code of ethics.

Healthcare workers with less advanced medical certifications than the Durhams often don't have the option of treating themselves or family members — or don't have savings to fall back on for healthcare expenses.

The Durhams saw the effects of unaffordable healthcare on their patients. They said they try to lend some leeway to patients when they can — a luxury they have, operating their own practice. In one case, Ashley Durham said, she wrote off $1,160 in bills for a single father whose son didn't have health insurance rather than send their bills to a collection agency.

"It's hard, because as a human I want to help them out," she said. "At the same time, we need revenue for our office."

Joshua Durham is more nervous about going uninsured than his wife. As a child, he witnessed his parents struggling to pay medical bills for their family of nine in south-central Idaho. Durham recalled that his dad, who was a carpenter, helped build a surgeon's house to pay for an operation.

Durham also sometimes exchanges work for care — he said he gets free eye exams from an uninsured optometrist and offers him free primary care.

So far, the couple paid about $9,000 total for expenses out of their health savings account this year. The expenses were higher than the Durhams anticipated, but still less than what their monthly premiums would have cost them.

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