How to report on health care affordability efforts
By Rose Hoban, North Carolina Health Journalism Fellowship
About half of Americans get their health coverage through an employer, according to the U.S. Census — and costs keep climbing. So why don’t employers band together to demand better prices? That question was among those tackled at a Health Journalism 2026 session on health care affordability moderated by Joe Burns, AHCJ’s Health Beat Leader for health policy and insurance.
Katie Martin from the Health Care Cost Institute kicked off the discussion noting that “while health care costs are high everywhere, they are highly variable based on where you live and what your health insurance market looks like.”
HCCI’s multi-payer, longitudinal commercial claims dataset covers one-third of the employer-sponsored population in the United States.
“For a given health care service, there is more than one price based on where you live, based on the insurance you have, depending on where you go,” Martin said. “The price of a regular vaginal delivery childbirth around the country, ranging in this slide from $14,000 in Detroit all the way up to $22,000 in Portland, Oregon.”
A more recent study found that hospital markets have grown increasingly non-competitive. Of 270 metro areas examined, 88% had either highly or very highly concentrated markets. Independent hospitals have shrunk from 32% of general acute care facilities to just 22%, replaced by system-affiliated hospitals that tend to charge higher prices with facility fees.
For people with private employer-sponsored insurance, one out of every two dollars spent on health care goes to a hospital — compared to about 40% in overall national health expenditures.
“All these things flow together as hospitals shift to become more system affiliated,” Martin said. “That’s partly why prices are higher.”
She said that in overall national health expenditures, about 40% goes to hospitals, but among people with private insurance who get insurance through work, one out of every two dollars goes to a hospital.
Shawn Gremminger of the National Alliance of Healthcare Purchaser Coalitions called health care affordability “the most important thing in health care.”
Health insurance is the second-largest line item on an employer’s balance sheet, after salaries. His organization’s annual survey of 350 employer members found that the share who say health care costs are hurting their competitiveness jumped from just over a third in 2022 to more than half in 2025.
One survey respondent put it bluntly: “The current environment is a dumpster fire with unlimited fuel as long as employers and plan sponsors put up with the status quo.”
Gremminger noted that U.S. health outcomes are worse than those in countries with national health care systems, and that American companies compete globally at a disadvantage because foreign competitors don’t carry the same insurance burden.
That loss of competitiveness affects U.S. companies’ global standing.
“U.S. companies are competing against companies that have a much bigger advance than we have,” Greminger said.
There are just a few choices for employers to rein in costs:
- Don’t offer coverage
- Cut back on benefits
- Higher out-of-pocket expenses for workers
- Get control of the underlying costs
Only the last option meaningfully addresses the problem — but it requires changing how the health system operates.
He urged journalists to focus attention on the roughly 150 million Americans covered by ERISA plans, the self-insured arrangements offered by large employers.
“The ERISA market covers more people than Medicare,” he said. “It covers more people than Medicaid. It covers a whole lot more than the individual market.”
Resources
- National Alliance of Healthcare Purchaser Coalitions.
- National Academy for State Health Policy has data on hospital cost and value.
- Session recording: There’s a lot more to this discussion and if you have 90 minutes, you can take a listen.
Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter.
