Pricey prescriptions and nagging medical costs are swamping some insurers and employers now. Patients may start paying for it next year.

Health insurance will grow more expensive in many corners of the market in 2026, and coverage may shrink. That could leave patients paying more for doctor visits and dealing with prescription coverage changes.

Price increases could be especially stark in individual coverage marketplaces, where insurers also are predicting the federal government will end some support that helps people buy coverage.

“We’re in a period of uncertainty in every health insurance market right now, which is something we haven’t seen in a very long time,” said Larry Levitt, an executive vice president at the nonprofit KFF, which studies health care.

What’s hitting insurers

In conference calls to discuss recent earnings reports, insurers ticked off a list of rising costs: More people are receiving care. Visits to expensive emergency rooms are rising, as are claims for mental health treatments.

Insurers also say more healthy customers are dropping coverage in the individual market. That leaves a higher concentration of sicker patients who generate claims.

Enrollment in the Affordable Care Act’s insurance marketplaces swelled the past few years. But a crackdown on fraud and a tightening of eligibility verifications that were loosened during the COVID-19 pandemic makes it harder for some to stay covered, Jefferies analyst David Windley noted.

People who use little care “are disappearing,” he said.

Prescription drugs pose another challenge, especially popular and expensive diabetes and obesity treatments sometimes called GLP-1 drugs. Those include Ozempic, Mounjaro, Wegovy and Zepbound.

“Pharmacy just gives me a headache, no pun intended,” said Vinnie Daboul, Boston-based managing director of the employee benefits consultant RT Consulting.

There are more super expensive drugs

New gene therapies that can come with a one-time cost of more than $2 million also are having an impact, insurance brokers say. Those drugs, which target rare diseases, and some newer cancer treatments are part of the reason Sun Life Financial covered 47 claims last year that cost over $3 million.

The financial services company covers high-cost claims for employers that pay their own medical bills. Sun Life probably had no claims that expensive a decade ago and maybe “a handful at best” five years ago, said Jen Collier, president of health and risk solutions.

Some of these drugs are rarely used, but they cause overall costs to rise. That raises insurance premiums.

“It’s adding to medical (cost growth) in a way that we haven’t seen in the past,” Collier said.

Marketplace pain is in the forecast

Price hikes will be most apparent on the Affordable Care Act’s individual coverage marketplaces. Insurers there are raising premiums around 20% in 2026, according to KFF, which has been analyzing state regulatory filings.

But the actual hike consumers see may be much bigger. Enhanced tax credits that help people buy coverage could expire at the end of the year, unless Congress renews them.

If those go away, customer coverage costs could soar 75% or more, according to KFF.

Business owner Shirley Modlin worries about marketplace price hikes. She can’t afford to provide coverage for the roughly 20 employees at 3D Design and Manufacturing in Powhatan, Virginia, so she reimburses them $350 a month for coverage they buy.

Modlin knows her reimbursement only covers a slice of what her workers pay. She worries another price hike might push some to look for work at a bigger company that offers benefits.

“My employee may not want to go to work for a large corporation, but when they consider how they have to pay their bills, sometimes they have to make sacrifices,” she said.
Employers may shift costs

Costs also have been growing in the bigger market for employer-sponsored coverage, the benefits consultant Mercer says. Employees may not feel that as much because companies generally pay most of the premium.

But they may notice coverage changes.

About half the large employers Mercer surveyed earlier this year said they are likely or very likely to shift more costs to their employees. That may mean higher deductibles or that people have to pay more before they reach the out-of-pocket maximum on their coverage.

Drug coverage changes are possible

For prescriptions, patients may see caps on those expensive obesity treatments or limits on who can take them.

Some plans also may start using separate deductibles for their pharmaceutical and medical benefits or having patients pay more for their prescriptions, Daboul said.

Coverage changes could vary around the country, noted Emily Bremer, president of a St. Louis-based independent insurance agency, The Bremer Group.

Employers aren’t eager to cut benefits, she said, so people may not see dramatic prescription coverage changes next year. But that may not last.

“If something doesn’t give with pharmacy costs, it’s going to be coming sooner than we’d like to think,” Bremer said.

A Virginia man pleaded guilty Friday in a federal case that accused him of stockpiling the largest number of finished explosives in FBI history and of using then-President Joe Biden’s photo for target practice.

Brad Spafford pleaded guilty in federal court in Norfolk to possession of an unregistered short barrel rifle and possession of an unregistered destructive device, according to court documents. Each count carries a maximum sentence of 10 years in prison. His sentencing is scheduled for December.

Federal authorities said they seized about 150 pipe bombs and other homemade devices last fall at Spafford’s home in Isle of Wight County, which is northwest of Norfolk.

The investigation into Spafford began in 2023 when an informant told authorities that Spafford was stockpiling weapons and ammunition, according to court documents. The informant, a friend and member of law enforcement, told authorities that Spafford was using pictures of then-President Joe Biden for target practice and that “he believed political assassinations should be brought back,” prosecutors wrote.

Two weeks after the assassination attempt of then-presidential candidate Donald Trump in 2024, Spafford told the informant, “bro I hope the shooter doesn’t miss Kamala,” according to court documents. Former Vice President Kamala Harris had recently announced she was running for president. On around the same day, Spafford told the informant that he was pursuing a sniper qualification at the local gun range, court records stated.

Spafford stored a highly unstable explosive material in a garage freezer next to “Hot Pockets and frozen corn on the cob,” according to court documents. Investigators also said they found explosive devices in an unsecured backpack labeled “#NoLivesMatter.”

Spafford has remained in jail since his arrest last December. U.S. District Judge Arenda L. Wright Allen ruled against his release last January, writing that Spafford has “shown the capacity for extreme danger.” She also noted that Spafford lost three fingers in an accident involving homemade explosives in 2021.

Spafford had initially pleaded not guilty to the charges in January. Defense attorneys had argued at the time that Spafford, who is married and a father of two young daughters, works a steady job as a machinist and has no criminal record.

Defense attorney Jeffrey Swartz said at Spafford’s January detention hearing that investigators had gathered information on him since January 2023, during which Spafford never threatened anyone.

“And what has he done during those two years?” Swartz said. “He purchased a home. He’s raised his children. He’s in a great marriage. He has a fantastic job, and those things all still exist for him.”

Investigators, however, said they had limited knowledge of the homemade bombs until an informant visited Spafford’s home, federal prosecutors wrote in a filing.

“But once the defendant stated on a recorded wire that he had an unstable primary explosive in the freezer in October 2024, the government moved swiftly,” prosecutors wrote.

The legal battle over President Donald Trump’s move to end birthright citizenship is far from over despite the Republican administration’s major victory Friday limiting nationwide injunctions.

Immigrant advocates are vowing to fight to ensure birthright citizenship remains the law as the Republican president tries to do away with more than a century of precedent.

The high court’s ruling sends cases challenging the president’s birthright citizenship executive order back to the lower courts. But the ultimate fate of the president’s policy remains uncertain.

Here’s what to know about birthright citizenship, the Supreme Court’s ruling and what happens next.

What does birthright citizenship mean?

Birthright citizenship makes anyone born in the United States an American citizen, including children born to mothers in the country illegally.

The practice goes back to soon after the Civil War, when Congress ratified the Constitution’s 14th Amendment, in part to ensure that Black people, including former slaves, had citizenship.

“All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States,” the amendment states.

Thirty years later, Wong Kim Ark, a man born in the U.S. to Chinese parents, was refused re-entry into the U.S. after traveling overseas. His suit led to the Supreme Court explicitly ruling that the amendment gives citizenship to anyone born in the U.S., no matter their parents’ legal status.

It has been seen since then as an intrinsic part of U.S. law, with only a handful of exceptions, such as for children born in the U.S. to foreign diplomats.

Trump has long said he wants to do away with birthright citizenship

Trump’s executive order, signed in January, seeks to deny citizenship to children who are born to people who are living in the U.S. illegally or temporarily. It’s part of the hardline immigration agenda of the president, who has called birthright citizenship a “magnet for illegal immigration.”

Trump and his supporters focus on one phrase in the amendment — “subject to the jurisdiction thereof” – saying it means the U.S. can deny citizenship to babies born to women in the country illegally.

A series of federal judges have said that’s not true, and issued nationwide injunctions stopping his order from taking effect.

“I’ve been on the bench for over four decades. I can’t remember another case where the question presented was as clear as this one is. This is a blatantly unconstitutional order,” U.S. District Judge John Coughenour said at a hearing earlier this year in his Seattle courtroom.

In Greenbelt, Maryland, a Washington suburb, U.S. District Judge Deborah Boardman wrote that “the Supreme Court has resoundingly rejected and no court in the country has ever endorsed” Trump’s interpretation of birthright citizenship.

Is Trump’s order constitutional? The justices didn’t say

The high court’s ruling was a major victory for the Trump administration in that it limited an individual judge’s authority in granting nationwide injunctions. The administration hailed the ruling as a monumental check on the powers of individual district court judges, whom Trump supporters have argued want to usurp the president’s authority with rulings blocking his priorities around immigration and other matters.

But the Supreme Court did not address the merits of Trump’s bid to enforce his birthright citizenship executive order.

“The Trump administration made a strategic decision, which I think quite clearly paid off, that they were going to challenge not the judges’ decisions on the merits, but on the scope of relief,” said Jessica Levinson, a Loyola Law School professor.

Attorney General Pam Bondi told reporters at the White House that the administration is “very confident” that the high court will ultimately side with the administration on the merits of the case.

Questions and uncertainty swirl around next steps

The justices kicked the cases challenging the birthright citizenship policy back down to the lower courts, where judges will have to decide how to tailor their orders to comply with the new ruling. The executive order remains blocked for at least 30 days, giving lower courts and the parties time to sort out the next steps.

The Supreme Court’s ruling leaves open the possibility that groups challenging the policy could still get nationwide relief through class-action lawsuits and seek certification as a nationwide class. Within hours after the ruling, two class-action suits had been filed in Maryland and New Hampshire seeking to block Trump’s order.

But obtaining nationwide relief through a class action is difficult as courts have put up hurdles to doing so over the years, said Suzette Malveaux, a Washington and Lee University law school professor.

“It’s not the case that a class action is a sort of easy, breezy way of getting around this problem of not having nationwide relief,” said Malveaux, who had urged the high court not to eliminate the nationwide injunctions.

The federal government says it’s freezing more than $2.2 billion in grants and $60 million in contracts to Harvard University, after the institution said it would defy the Trump administration’s demands to limit activism on campus.

The hold on Harvard’s funding marks the seventh time President Donald Trump’s administration has taken the step at one of the nation’s most elite colleges, in an attempt to force compliance with Trump’s political agenda. Six of the seven schools are in the Ivy League.

It sets the stage for a showdown between the federal government and America’s oldest and wealthiest university. With an endowment of more than $50 billion, Harvard is perhaps the best positioned university to push back on the administration’s pressure campaign.

In a letter to Harvard Friday, Trump’s administration had called for broad government and leadership reforms at the university, as well as changes to its admissions policies. It also demanded the university audit views of diversity on campus, and stop recognizing some student clubs.

The federal government said almost $9 billion in grants and contracts in total were at risk if Harvard did not comply.

On Monday, Harvard President Alan Garber said the university would not bend to the government’s demands.

“The University will not surrender its independence or relinquish its constitutional rights,” Garber said in a letter to the Harvard community. “No government — regardless of which party is in power — should dictate what private universities can teach, whom they can admit and hire, and which areas of study and inquiry they can pursue.”

Hours later, the government froze billions in Harvard’s federal funding.

The first university targeted by the Trump administration was Columbia, which acquiesced to the government’s demands under the threat of billions of dollars in cuts. The administration also has paused federal funding for the University of Pennsylvania, Brown, Princeton, Cornell and Northwestern.

Trump’s administration has normalized the extraordinary step of withholding federal money to pressure major academic institutions to comply with the president’s political agenda and to influence campus policy. The administration has argued universities allowed antisemitism to go unchecked at campus protests last year against Israel’s war in Gaza.

Harvard, Garber said, already has made extensive reforms to address antisemitism. He said many of the government’s demands don’t relate to antisemitism, but instead are an attempt to regulate the “intellectual conditions” at Harvard.

Withholding federal funding from Harvard, one of the nation’s top research universities in science and medicine, “risks not only the health and well-being of millions of individuals but also the economic security and vitality of our nation.” It also violates the university’s First Amendment rights and exceeds the government’s authority under Title VI, which prohibits discrimination against students based on their race, color or national origin, Garber said.

The government’s demands included that Harvard institute what it called “merit-based” admissions and hiring policies and conduct an audit of the study body, faculty and leadership on their views about diversity. The administration also called for a ban on face masks at Harvard — an apparent target of pro-Palestinian campus protesters — and pressured the university to stop recognizing or funding “any student group or club that endorses or promotes criminal activity, illegal violence, or illegal harassment.”

Harvard’s defiance, the federal antisemitism task force said Monday, “reinforces the troubling entitlement mindset that is endemic in our nation’s most prestigious universities and colleges — that federal investment does not come with the responsibility to uphold civil rights laws.

U.S. immigration officials are asking the public and federal agencies to comment on a proposal to collect social media handles from people applying for benefits such as green cards or citizenship, to comply with an executive order from President Donald Trump.

The March 5 notice raised alarms from immigration and free speech advocates because it appears to expand the government’s reach in social media surveillance to people already vetted and in the U.S. legally, such as asylum seekers, green card and citizenship applicants -- and not just those applying to enter the country. That said, social media monitoring by immigration officials has been a practice for over a decade, since at least the second Obama administration and ramping up under Trump’s first term.

The Department of Homeland Security issued a 60-day notice asking for public commentary on its plan to comply with Trump’s executive order titled “Protecting the United States from Foreign Terrorists and Other National Security and Public Safety Threats.” The plan calls for “uniform vetting standards” and screening people for grounds of inadmissibility to the U.S., as well as identify verification and “national security screening.” It seeks to collect social media handles and the names of platforms, although not passwords.

The policy seeks to require people to share their social media handles when applying for U.S. citizenship, green card, asylum and other immigration benefits. The proposal is open to feedback from the public until May 5.

“The basic requirements that are in place right now is that people who are applying for immigrant and non-immigrant visas have to provide their social media handles,” said Rachel Levinson-Waldman, managing director of the Brennan Center’s Liberty and National Security Program at New York University. “Where I could see this impacting is someone who came into the country before visa-related social media handle collection started, so they wouldn’t have provided it before and now they’re being required to. Or maybe they did before, but their social media use has changed.”

“This fairly widely expanded policy to collect them for everyone applying for any kind of immigration benefit, including people who have already been vetted quite extensively,” she added.

What this points to — along with other signals the administration is sending such as detaining people and revoking student visas for participating in campus protests that the government deems antisemitic and sympathetic to the militant Palestinian group Hamas — Levinson-Waldman added, is the increased use of social media to “make these very high-stakes determinations about people.”

In a statement, a spokesperson for the United States Citizenship and Immigration Service said the agency seeks to “strengthen fraud detection, prevent identity theft, and support the enforcement of rigorous screening and vetting measures to the fullest extent possible.”

“These efforts ensure that those seeking immigration benefits to live and work in the United States do not threaten public safety, undermine national security, or promote harmful anti-American ideologies,” the statement continued. USCIS estimates that the proposed policy change will affect about 3.6 million people.
How are social media accounts used now?

The U.S. government began ramping up the use of social media for immigration vetting in 2014 under then-President Barack Obama, according to the Brennan Center for Justice. In late 2015, the Department of Homeland Security began both “manual and automatic screening of the social media accounts of a limited number of individuals applying to travel to the United States, through various non-public pilot programs,” the nonpartisan law and policy institute explains on its website.

In May 2017, the U.S. Department of State issued an emergency notice to increase the screening of visa applicants. Brennan, along with other civil and human rights groups, opposed the move, arguing that it is “excessively burdensome and vague, is apt to chill speech, is discriminatory against Muslims, and has no security benefit.”

Two years later, the State Department began collecting social media handles from “nearly all foreigners” applying for visas to travel to the U.S. — about 15 million people a year.