Rising Health Insurance Premiums Are Engineered to Hit Black Families Hardest
Rising health insurance premiums are no longer a future concern. They are already embedded in 2026 rates as enhanced Affordable Care Act subsidies expire and insurers shift higher costs onto workers. While policymakers frame the increases as affecting everyone, evidence shows rising health insurance premiums disproportionately burden Black families and Black-owned businesses. Historical inequities, wage gaps, and systemic barriers to care mean Black households pay more out-of-pocket while receiving less access, turning racialized harm into predictable revenue for the health care industry.
Health insurance premiums are already climbing, insurers have locked in higher 2026 rates, and the enhanced Affordable Care Act subsidies that have kept coverage affordable for millions expired on Jan. 1, 2026.
The increases are no longer hypothetical. They are visible now, baked into open enrollment, and poised to accelerate in the coming year. For many workers, this won’t just show up as a higher monthly bill. It will show up directly in their paychecks, as employers shift rising health care costs onto employees through higher premium contributions, reduced benefits, and slower wage growth.
Policymakers and insurers insist this will affect “everyone.” Middle-class families of all races are struggling. And that is true. But it is also incomplete because the early evidence shows the burden will fall hardest on Black families and businesses.
The American health care system likes to present itself as colorblind, clinical and mathematical. It is largely driven by data, risk pools, utilization rates, and actuarial tables that supposedly strip emotion and politics out of life-and-death decisions. We are told that rising premiums are unfortunate but inevitable, that the health care system is strained, and that nobody is being unfairly targeted.
But this is America, where numbers don’t float above history or erase bias. What recent reporting on rising health care costs reveals, often without fully naming, is that the health care system is engineered to convert racialized harm into predictable revenue that disproportionately falls on Black folks.
A JAMA report has shown that overall costs are higher for Black and Latino households, with Black families often paying more out-of-pocket for care and insurance even as they face systemic barriers to access. Another analysis from the Economic Policy Institute argues that proposals to end Affordable Care Act tax credits will hit Black Americans especially hard.
In 10 major metropolitan areas, such changes could leave over 170,000 people without insurance, drive up annual premiums by roughly $740 million, and increase preventable deaths. Healthcare Finance has noted that premium increases are outpacing wage growth, with Black and Hispanic workers feeling those pressures acutely.
These reports describe outcomes such as higher costs, lost coverage, sticker shock, and preventable deaths, but they stop short of naming who benefits and why the system keeps producing the same racialized harm on schedule. Readers are left with the sense that this is unfortunate, cyclical, or merely a matter of policy negligence, rather than the predictable result of an industry engineered to extract wealth from people least able to absorb it.
What’s happening with health care in our current moment did not emerge from recent policy shifts, but rather a century-long continuum of racialized medical extraction, exclusion, and pricing. It’s connected to redlining’s impact on hospital access, employer-based insurance as a Jim Crow labor workaround, and desegregation, which triggered white flight from public health infrastructure.
Without that context, Black folks appear as perpetual victims of “rising costs,” rather than communities that have been systematically positioned to subsidize everybody else’s care through higher premiums, worse coverage, and delayed treatment.
And there’s corporate culpability. Insurers, pharmaceutical companies, hospital conglomerates, private equity firms, and consulting giants appear as abstractions in these reports. There’s no sustained interrogation of pricing algorithms, risk scoring, provider consolidation, or shareholder expectations. These are mechanisms that quietly convert Black illness into revenue. And they are the result of deliberate choices by specific lawmakers responding to donors and industry pressure.
These stories also don’t fully explore how constant cost anxiety reshapes medical decision-making in Black households. People skip care, delay prescriptions, ration insulin, avoid emergency rooms, and choose debt over diagnosis. That stress is a health condition in itself, one that compounds hypertension, heart disease, pregnancy outcomes, and mortality. The body is paying interest on policy.
At the end of the day, Black people are not just a disproportionately affected group, but they are the financial backbone of the healthcare system. Black families aren’t just harmed by rising costs. They are overpaying into a system that routinely underserves them. That inversion matters. Without it, these stories document injustice but don’t fully expose exploitation.
Black illness, stress, exposure, deprivation, and Black survival itself are not aberrations to the model. They are inputs. They are priced in. And as health care costs rise, Black people will be disproportionately extracted from, disciplined by, and charged for injuries they did not choose and cannot escape.
Dr. Stacey Patton is a writer for Word in Black & other national publications.
Edited for length by Minnesota Spokesman-Recorder.