Healthcare affordability remains one of the most persistent and complex challenges facing policymakers, providers and employers today. While coverage rates have improved in recent years, being insured does not always translate into affordable access. High deductibles, co-pays and other out-of-pocket expenses continue to create financial strain, particularly for lower-income and vulnerable populations who may technically have coverage but still struggle to use it.
A Harvard analysis of rising health insurance premiums highlights how costs continue to increase for many Americans, particularly as enhanced subsidies expire, forcing more individuals to shoulder higher financial burdens. This dynamic not only limits access to timely care but also contributes to a cycle of delayed treatment and escalating healthcare spending.
The challenge, then, is not simply reducing costs, but doing so in a way that improves access, maintains actuarial balance and avoids shifting financial burdens elsewhere. Insights from the Senior Executive Healthcare Think Tank—a curated group of leaders across patient experience, policy, workforce strategy and health technology—offer a nuanced view of how targeted reforms can do exactly that: deliver affordability where it is needed most without creating unintended consequences across the healthcare ecosystem.
“All healthcare providers should be required to offer a basic plan for under $300 per month.”
Build a Baseline of Affordable, Comprehensive Care
Mark Francis, Founder and CEO of CaregiverZone, a company focused on supporting independent living and aging-in-place, argues that affordability must begin with a guaranteed baseline of accessible care.
Francis says, “To expand access to lower-income and vulnerable populations, all healthcare providers should be required to offer a basic plan for under $300 per month.” He emphasizes that such a plan should not be bare-bones, but instead include “24/7/365 virtual care, $0 co-pay for key pharmaceutical products, wellness offerings and a $200 spending card for services to address social determinants of health.”
He adds that virtual care must be robust and comprehensive: “Primary care, emergency care, tele-dentistry, tele-therapy, maternal care and weight management” should all be included.
This approach reflects a growing body of evidence supporting virtual care as a cost-reduction lever. A 2026 Penn Medicine study found that telehealth visits for common conditions were about five times less expensive than in-person care and often required fewer follow-up visits, reducing total healthcare spending.
Francis also highlights the importance of integrating pharmacy and social support: “The pharmacy benefit can be offered in conjunction with GoodRx, Cost Plus Drug or Amazon Pharmacy. The SDoH services can include transportation, groceries, child or elder care support and personal emergency response services.”
By bundling these services into a standardized, affordable plan, Francis’ model aims to address both medical and non-medical drivers of health—without fragmenting the system or increasing administrative complexity.
“Countries with universal healthcare often achieve better overall health outcomes because everyone has access to care.”
Expand Preventive Access Through Sliding-Scale Models
Anna Koskinaris of Supreme Health Solutions points to international models as evidence that broader access can coexist with cost control.
“Countries with universal healthcare often achieve better overall health outcomes because everyone has access to care,” she says, noting that while wait times can be longer, “costs are managed more effectively and sustainably over time.”
Her proposed solution focuses on expanding sliding-scale coverage and preventive care access. “By expanding sliding-scale coverage and increasing awareness and access to preventative services, governments can move toward a more equitable system,” she explains.
Crucially, she emphasizes behavior change: “Individuals feel encouraged and supported to seek care early, rather than delay treatment, which often leads to more serious and expensive health issues and increased costs later on.”
Her approach emphasizes a key principle: Affordability reforms should not just lower costs at the point of care but reshape utilization patterns toward prevention.
Use AI Governance to Ensure Fairness and Accountability
Jordan Henry, Founder and Chief AI Ethicist at Veritas AI Consulting, brings a governance-focused approach to affordability.
“Rising premiums and out-of-pocket costs burden lower-income and vulnerable populations,” Henry says, emphasizing that reforms must prioritize “fairness, transparency and accountability.”
He advocates for income-scaled subsidies and progressive funding models, paired with rigorous oversight: “Equity impact assessments block cost-shifting.”
Henry also highlights the role of technology in both the problem and the solution. “Deploy transparent, audited risk-adjustment algorithms in insurance, like bias-audited clinical AI,” he says.
Oversight is critical: “Independent oversight boards with clinicians, ethicists and patients oversee the full lifecycle from design to review. Value-based, preventive incentives finalize it.”
These “enhance affordability without distorting markets or widening inequities,” Henry says, highlighting that affordability reforms must include governance mechanisms to ensure that innovations do not unintentionally deepen disparities.
Smooth Subsidy Cliffs and Stabilize Premiums
Carolyn Hillegass, CEO and Executive Coach at The Outcomes Coach, focuses on one of the most overlooked affordability challenges: the subsidy cliff.
“Rising insurance premiums are the first affordability barrier, especially for families who earn just a little too much to qualify for subsidies,” she says.
Her solution is targeted but impactful: “Expand premium subsidies further up the income scale, smooth the subsidy cliff and fund reinsurance programs to keep marketplace premiums stable.”
She also stresses the importance of reducing cost-sharing for essential services: “When paired with lower deductibles and co-pays on essential care, chronic disease medications, preventive visits and mental health care, coverage would translate to patient access to care.”
However, Hillegass warns of unintended consequences if reforms are not carefully funded. “Without broad-based financing, costs will quietly shift onto employer plans and working families,” she says.
Hillegass’ perspective reinforces the importance of system-wide thinking: Affordability gains in one segment should not come at the expense of another.
Shift From Volume to Value in Care Delivery
Mahendran Chinnaiah, a Digital Healthcare Architect at a major U.S. healthcare and pharmacy services firm, argues that affordability cannot be achieved without fundamentally changing how care is incentivized.
“We must transition from transactional care to Value-Based Insurance Design,” he says.
Chinnaiah explains that “high premiums are symptoms of a system that rewards the volume of services over the quality of outcomes.”
His proposed reform removes financial barriers at critical points: “By adopting reforms that eliminate co-pays for chronic care and prevention, we remove the financial entry barrier for low-income patients.”
He frames this as an economic imperative: “Treating a health issue early is far cheaper than managing a crisis in the ER.”
Chinnaiah concludes, “This shift doesn’t just help the vulnerable; it stabilizes the entire risk pool by reducing high-cost medical events. True affordability is achieved when we stop billing for sickness and start investing in health architecture.”
Align Cost Sharing With Income and Utilization
Sriharsha Chavali, Enterprise Technology Leader at The Aspen Group, brings a data-driven perspective grounded in real-world clinical systems.
“When building clinical surveillance systems across 174 hospitals, I watched delayed care turn manageable conditions into ICU admissions,” he says. “The cost driver wasn’t clinical—it was financial.”
Chavali identifies a key gap: “People who earn just enough to be ineligible for Medicaid often face full deductibles and delay treatments, even when early care costs far less.”
His solution centers on precision in cost-sharing design. “Two reforms can help: income-based cost sharing and expanded premium subsidies for higher income levels,” he explains.
To avoid unintended consequences, he stresses careful implementation: “Subsidies should phase out gradually, verification should stay simple and actuarial balance should be preserved.”
The payoff is significant: “These reforms encourage earlier treatments, resulting in better outcomes and reducing avoidable high-cost utilization—a win-win for both patients and insurers.”
Practical Steps to Improve Healthcare Affordability
- Establish a baseline of affordable, comprehensive care. Standardized low-cost plans that integrate virtual care, pharmacy benefits and social support can expand access without fragmenting delivery.
- Expand sliding-scale coverage and preventive care access. Encouraging early intervention reduces long-term costs and improves outcomes across populations.
- Embed fairness and oversight into AI and policy design. Transparent governance structures help prevent cost-shifting and inequities in emerging healthcare systems.
- Smooth subsidy cliffs and stabilize premiums. Gradual phaseouts and reinsurance programs can prevent coverage gaps without shifting costs elsewhere.
- Adopt value-based insurance design. Eliminating cost barriers for preventive and chronic care aligns incentives with better outcomes and lower system costs.
- Align cost sharing with income levels. Gradual, income-based models encourage timely care while preserving actuarial balance.
Building a System That Works
Making healthcare truly affordable isn’t about a single policy fix or sweeping reform. It’s about addressing the everyday realities that prevent people from getting care in the first place—whether that’s high out-of-pocket costs, confusing coverage gaps or incentives that reward treatment over prevention.
The ideas shared by the Senior Executive Healthcare Think Tank point to a more practical path forward. Expanding access, aligning costs with income, investing in prevention and building accountability into both policy and technology aren’t competing priorities—they reinforce each other when designed well.
What stands out is that many of these solutions are not theoretical. They’re actionable, targeted and capable of improving access without destabilizing the broader system. The real challenge is in how thoughtfully they’re implemented.
Affordability, in the end, is less about lowering prices in isolation and more about building a system that works earlier, more fairly and more predictably for the people who rely on it most.
