We could stand to be more outraged about healthcare in the United States. In conversations about economic mobility, we discuss jobs, housing, transportation, and education, but neglect one of the largest and least predictable expenses for a family. And while there is limited to no urgency within the federal government to build an affordable healthcare system, we have to ask: can we deliver true economic mobility for every American without prioritizing their medical expenses?
Let’s dive in.
Jared Giles
Founder, SquareOne
[email protected]
Gif by news on Giphy
An Unpredictable Tax on Americans
Conversations about economic mobility usually include talk about jobs, wages, housing, and education. But for millions of American families, the greatest single threat to upward mobility is an unpredictable medical expense.
The crisis hit a new tipping point last year after the One Big Beautiful Bill Act passed, which eliminated key healthcare tax subsidies and rolled back funding for expanded coverage. In New York, for example, the rollback slashed income eligibility for the state’s $0 premium Essential Plan from 250% down to 200% of the federal poverty line. As a result, roughly 450,000 New Yorkers were pushed off low- to no-cost care into the individual marketplace, where the lowest available monthly premium for a single individual can exceed $600 per month. And that’s before you account for prescriptions and co-pays.
When medical expenses consume such a massive amount of household income, healthcare becomes the primary drain on economic mobility.
When we look at the data, the scale of medical debt across the nation is daunting:
The Debt Burden: Over 20 million Americans, roughly 1 in 12 adults, carry past-due medical debt over $250.
Daily Trade-Offs: Research from West Health and Gallup indicates that 82 million Americans have had to make severe trade-offs between prescription drugs, food, rent, and education. To pay medical bills, 15% of adults have borrowed money and 11% report skipping meals.
Sacrificing Futures: About 1 in 6 working Americans have an outstanding loan against their retirement account. The top two reasons for those loans are housing and healthcare.
Medical expenses burden families with impossible daily choices and often force them to forgo care because they cannot afford the expense. This can compound into stress from looming debt, more severe injury or illness, loss of work, an even higher medical bill, or the unnecessary and premature loss of a family member.
If our goal is long-term economic mobility, we must prioritize a healthcare strategy that protects families and ensures reliable, affordable care for every American.
National Spotlight: Maryland’s Health Services Cost Review Commission (HSCRC)
How do we align health systems around community outcomes? Maryland is capping hospital revenues across the state to eliminate volume-based pricing.
The Problem: Traditional fee-for-service healthcare incentivizes hospitals to maximize patient volume which drives up overall health expenditures and shifts catastrophic out-of-pocket costs onto families.
The Intervention: Through the Health Services Cost Review Commission (HSCRC), Maryland operates an "all-payer" global budget system. Instead of billing per procedure, all hospitals receive a fixed, pre-set annual revenue cap regardless of patient volume across Medicare, Medicaid, and private insurers.
The Takeaway: By capping annual revenues, Maryland transforms hospitals into preventive health providers. Hospital business models are instead incentivized to keep patients healthy, out of emergency rooms, and away from financial burden.
ICYMI
[READ] PBS: Since February 2026, about 3 million Americans have dropped coverage under the Affordable Care Act.
[READ] NPR: Article detailing how Phifer, a manufacturer, opened a clinic to control its own healthcare costs and prevent its employees from falling into debt.
[REPORT] Peterson-KFF Health Systems Tracker: A deep dive breaking down medical debt across the United States.