Premium Inflation Is Reshaping Patient Access and Adherence

According to Alan Balch, PhD, CEO of the Patient Advocate Foundation and the National Patient Advocate Foundation, rising employer-sponsored insurance premiums—outpacing both inflation and wage growth—are creating severe financial pressure for low- and middle-income families. He describes a “perfect storm” in which healthcare costs are increasing alongside everyday expenses such as housing, food, and utilities, while household incomes fail to keep pace. For many families already managing serious or chronic illnesses, this imbalance forces painful trade-offs that directly affect access to care.

Balch emphasizes that these decisions are not discretionary or short-term choices, such as whether to seek treatment for a minor illness. Instead, patients are weighing essential household expenses against life-sustaining therapies for conditions like cancer, HIV, or diabetes. From a patient’s perspective, all out-of-pocket costs—insurance premiums, coinsurance, deductibles, medications, or basic living expenses—come from the same limited pool of income. As healthcare spending rises, patients face compounding financial strain.

The burden is often amplified by lost wages when illness requires time away from work, further reducing household income while medical expenses simultaneously increase. This dual pressure leaves families with little flexibility and increases the likelihood that they will delay or forgo necessary care. Balch notes that patients are increasingly forced to decide between paying rent, utilities, or groceries and covering the remaining costs of their healthcare.

These financial trade-offs have serious clinical and economic consequences. When patients postpone or skip treatment due to cost, diseases can progress, complications become more severe, and interventions become more complex, less effective, and more expensive over time. What initially appears as a short-term cost-saving decision ultimately leads to higher overall healthcare spending and worse health outcomes.

Balch’s perspective underscores the broader affordability crisis facing working families and highlights how rising premiums and out-of-pocket costs are eroding the ability of patients to remain insured, stay adherent to treatment, and maintain financial stability while managing serious illness.

He also discussed the policy solutions that advocates should prioritize and much more.

A transcript of his conversation with PC can be found below.

PC: With employer-sponsored premiums continuing to rise well above inflation and wage growth, what specific financial impacts are you seeing on patients, and how does this affect their access to care or decision to stay insured?

Balch: For most low- and middle-income families, it's a perfect storm of costs across the board are rising, not just healthcare costs, but costs related to food, housing, utilities, etc., and many families’ incomes are not keeping pace with those cost increases, so then you get in a position where you're going to have to make a trade off, and these are people who are actively being treated for disease.

It’s not like the choices, go to the doctor for a flu or not pay the out-of-pocket costs associated with this. These are pretty significant trade-offs they're having to make between paying utility bill or paying for their cancer therapy or their medication for HIV or diabetes, for example. What happens is, you can naturally conclude that when faced with increasing out-of-pocket costs, you for patients, it doesn't matter where the out-of-pocket cost is coming from, it's all coming out of their pocket.

Whether it's in the form of insurance premiums or coinsurance or a trip to the grocery store, those are all things that they have to pay for. And if you're in the midst of disease, you're going to have more out-of-pocket expense for your treatment. You're also probably going to be losing time off work, so you're going to be missing some wages at the same time. There's some downward pressure on your income if there wasn't already, and then you have rising pressure for costs for treatment and other things as well. Really what happens is you have to make trade-offs, and we see patients having to decide between paying their rent or mortgage or the utility bill, or paying for the last thing they have to pay for in their healthcare journey.

That’s the challenge, and when patients go without treatment, then what happens is the disease gets worse, the complications progress, and then ultimately, treatment costs, the interventions for treatment cost more, are less efficacious, and are more complicated.