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中期选举临近,许多人担忧医疗保健成本。其费用为何持续上涨Many are worried about healthcare costs as midterms approach. Why they keep rising

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听诊器和钢笔的库存图片。Krisanapong Detraphiphat/STOCK PHOTO/Getty ImagesStock image of a stethoscope and pen. Krisanapong Detraphiphat/STOCK PHOTO/Getty Images

根据近期民调显示,在美利坚人准备在周二的中期选举中投票之际,医疗保健成本上升是他们最为关心的财政和经济问题之一。

Americans prepare to vote in Tuesday's midterm elections, rising healthcare costs are among the top financial and economic concerns, according to recent polling.

根据凯泽家庭基金会(KFF)本月早些时候的一项民调,四分之一的选民表示他们对能否承担得起医疗保健费用“非常担忧”,超过三分之一的选民表示他们“有点担忧”。

A quarter of voters say they are "very worried" about being able to afford healthcare costs and more than one-third say they are "somewhat worried," according to a KFF poll earlier this month.

根据凯泽家庭基金会的统计,通过《平价医疗法案》(ACA)获得健康保险的人群,其平均每月基准保费从2025年的每月497美元飙升至2026年的625美元,特别是在去年年底增强型保费税收抵免到期之后。

Those who get their health insurance through the Affordable Care Act (ACA) saw their average monthly benchmark premium jump from $497 per month in 2025 to $625 in 2026, according to KFF, particularly after enhanced premium tax credits expired at the end of last year.

凯泽家庭基金会周五发布的一项新分析发现,《平价医疗法案》下医疗保健计划的最终敲定基准白银级保费明年将平均上涨13%,标志着百分比增幅连续第二年达到两位数。

A new analysis from KFF published Friday found that finalized benchmark silver premiums for healthcare plans under the ACA will rise by an average of 13% next year, marking the second year in a row of double-digit percentage increases.

甚至连拥有雇主赞助健康保险的人群,其保费也在上涨。根据凯泽家庭基金会本月早些时候发布的一项新调查,工人们为其保费支付的费用增加了近10%。

Premiums have risen even for those with employer-sponsored health insurance. Workers are paying nearly 10% more for their premiums, according to a new KFF survey published earlier this month.

根据凯泽家庭基金会的数据,自2015年以来,工人的平均单人覆盖免赔额增加了43%,在2025年达到了1886美元。

The average single-coverage deductible for workers increased by 43% since 2015, according to KFF, reaching $1,886 in 2025.

美国卫生系统药剂师协会(ASHP)的一份报告发现,处方药支出在2025年增长了12.7%,达到9150亿美元,并有望在2026年超过1万亿美元。

Prescription drug spending rose in 2025 by 12.7% to $915 billion and is on track to surpass $1 trillion in 2026, a report from the American Society of Health-System Pharmacists (ASHP) found.

根据美国退休人员协会(AARP)公共政策研究所今年的一份报告,自进入美国市场以来,前25大知名品牌药物的价格平均上涨了81%。

The top 25 brand-name drugs have seen their prices increase by an average of 81% since entering the U.S. market, according to a report this year from AARP's Public Policy Institute.

尽管处方药支出的增加和更高的保险保费是导致这一现象的因素,且许多美国选民正面临着惊人的高价,但一些医疗保健和经济政策专家表示,医疗成本上升还有许多其他原因,美利坚人在看到任何缓解之前可能会经历短期的阵痛。

While prescription drug spending and higher insurance premiums are contributing factors, as many U.S. voters face sticker shock, some healthcare and economic policy experts say there are many other reasons why health costs are rising, and that Americans may experience short-term pain before seeing any relief.

乔治敦大学麦考特公共政策学院下属的医疗保险改革中心研究教授、创始兼联席主任萨布里纳·科尔莱特(Sabrina Corlette)对美国广播公司新闻(ABC News)表示:“就目前而言,我看不出短期内会有什么灵丹妙药能把成本降下来。”科尔莱特表达了对未来几年价格还会进一步上涨的担忧。

"At this point in time, I am not seeing that there's going to be any sort of magic bullet in the short term to bring costs down," Sabrina Corlette, a research professor, founder and co-director of the Center on Health Insurance Reforms at Georgetown University McCourt School of Public Policy, told ABC News. Corlette expressed concern that prices will rise even more in the coming years.

她说:“我讨厌在这里泼冷水,但我认为情况在好转之前会先恶化。”以下是一些专家指出医疗保健成本近期上涨的三个原因。

"I hate to be a Debbie Downer here, but I think it's [going to] get worse before it gets better," she said. Here are three reasons some experts say are why healthcare costs have risen recently.

这些专家对美国广播公司新闻表示,据报道,最近有更多的医疗服务提供者——包括医院和医生诊所——正在使用环境人工智能(AI)记录员来记录就诊情况、扫描化验结果并生成病历,以减轻医生的行政工作负担。

The experts told ABC News that, recently, more providers -- including hospitals and doctors' offices -- are reportedly using ambient artificial intelligence (AI) scribes to document visits, scan lab results and generate medical notes to reduce administrative tasks for physicians.

包括蓝十字蓝盾在内的保险公司以及包括特里利亚特健康公司(Trilliant Health)在内的医疗保健分析公司均已指出,这类记录员的使用正导致二级诊断的出现,甚至导致患者接受的医疗服务与发给保险公司的账单不匹配。

Insurance companies, including Blue Cross Blue Shield, and healthcare analytics companies, including Trilliant Health, have suggested the use of such scribes is leading to secondary diagnoses or even a mismatch between the care patients receive and the bills sent to insurance companies.

耶鲁大学公共卫生与经济学副教授、耶鲁大学医疗保健可负担性实验室主任扎克·库珀(Zack Cooper)对美国广播公司新闻表示:“医疗服务提供者已经采用了一些新的人工智能工具,其中一个似乎正在带来更激进的编码。”

"There's been the adoption of some new AI tools used by providers and one of the things that that seems to be allowing is more aggressive coding," Zack Cooper, an associate professor of public health and economics at Yale University and director of the Health Care Affordability Lab at Yale, told ABC News.

库珀表示,某些人工智能工具的使用正将一些患者推入更高的计费类别。

Cooper said the use of some AI tools is pushing some patients into higher billing categories.

科尔莱特分享了她对此的一次个人经历,当时她去看医生做年度体检,并表示自己生平第一次需要支付挂号共付额。

Corlette shared a personal experience with this, during which she visited a doctor for an annual check-up and said she had a co-payment for the first time.

科尔莱特说,她的医生在就诊开始时告诉她,诊所正在使用环境记录员。

Corlette said her doctor told her an ambient scribe was being used at the start of her visit.

科莱特说,当她打电话给诊所询问自付费用的情况时,“他们的态度是:‘嗯,你问了一个使你的就诊不再属于预防性范畴的问题。相反,它变成了一次诊断性就诊,这意味着你负有分摊费用的义务。’”科莱特接着说:“这字面意思上就像是一个持续20秒的问答,我想正常情况下,如果只是我和我的医生,她可能都不会费心把它写进病历里。但是环境转录员捕捉到了那段对话,把它记录下来,然后在理赔表格上将其转化为了更高的代码。”科莱特说她支付了这笔自付费用。

When she called the doctor's office to ask about the co-pay, "they were like, 'Well, you asked a question that made your visit no longer preventive. Instead, it became a diagnostic visit, and so that means that you have a cost-sharing obligation,'" Corlette said. "It was literally like a 20-second question and answer that I think normally, if it was just me and my doctor, she probably wouldn't have bothered to put it into the notes," Corlette continued. "But the ambient scribe picked up that conversation, put it in and then turned it into a higher code on the claims form." Corlette said she paid the co-pay.

科莱特表示,人工智能的使用似乎会导致保险公司理赔成本上升,但很难确定这在长期内对整体医疗保健成本意味着什么。

Corlette said it seems the use of AI could result in higher claims costs for insurance companies, but it's hard to determine what this will mean in terms of overall healthcare costs in the long-term.

她补充说,保险公司也被指控使用人工智能来拒绝提供医疗服务或理赔报销。2023年11月,针对联合健康集团提起了一起诉讼,称其旗下一家子公司在没有人工审核的情况下,使用人工智能程序拒绝了针对急性期后护理的理赔申请。该案件目前仍在进行中。

She added that insurance companies have also been accused of using AI to deny care or coverage. In November 2023, a lawsuit was filed against UnitedHealthcare, claiming one of its subsidiaries denied claims for post-acute care using an artificial intelligence program without human review. The case is ongoing.

联合健康集团对美国广播公司新闻部表示,其“预测工具”并未被用于做出不利的理赔决定,而是用于向家属、护理人员和医疗服务提供者提供关于患者在医疗机构中以及回家后可能需要哪些护理或服务的信息。“我们认为这起诉讼毫无依据,并期待着大力捍卫我们自己,”联合健康集团说。

UnitedHealthcare told ABC News its "predict tool" is not used to make adverse coverage determinations, but rather to provide information to families, caregivers and providers on what care or services a patient may need in a facility and after returning home "We believe the lawsuit has no merit and we look forward to vigorously defending ourselves," UnitedHealthcare said.

此外,参议院小组委员会2024年的一份报告发现,在使用自动化工具、预测技术或人工智能增多之后,Humana公司和联合健康集团的联邦医疗保险优势计划(Medicare Advantage plans)中急性期后护理的拒绝率,以及CVS公司需要事先授权的急性期后护理申请的拒绝率,都显著上升。

Additionally, a 2024 Senate subcommittee report found denial rates for post-acute care in Humana and UnitedHealthcare's Medicare Advantage plans and post-acute requests subjected to prior authorization for CVS rose significantly after increased use of automated tools, predictive technologies or AI.

CVS在一份声明中告诉美国广播公司新闻部,该公司已投资于人工智能和其他技术,以简化流程并改善患者、医疗服务提供者和CVS员工的体验。

CVS told ABC News in a statement that the company has invested in AI and other technologies to streamline processes and improve experiences for patients, providers and CVS employees.

CVS在一份声明中表示:“我们从不使用人工智能来拒绝理赔,而是用它来加速实时批准事先授权、加快向医疗服务提供者付款,并让我们的同事能够提供更有效、更高质量的客户服务。”

"We never use AI to deny claims, but instead to accelerate real-time approvals of prior authorizations, expedite payment to providers and enable our colleagues to deliver more effective and efficient customer service," CVS said in a statement.

联合健康集团在给美国广播公司新闻部的声明中表示,该报道“歪曲了联邦医疗保险优越计划(Medicare Advantage)和我们的临床实践”,并且忽视了美国医疗保险和医疗补助服务中心“要求对急性期后护理进行更严格审查”的标准。该保险公司的声明写道:“与参加传统联邦医疗保险的受益人相比,联邦医疗保险优越计划的会员自付费用降低了45%,可避免的住院率降低了40%以上,满意度达到96%——所有这一切都为政府降低了成本。”

In a statement to ABC News, UnitedHealthcare said the report "mischaracterizes the Medicare Advantage program and our clinical practices," and ignored criteria from the Centers for Medicare & Medicaid Services that "demanded greater scrutiny around post-acute care." "Compared to beneficiaries enrolled in Original Medicare, Medicare Advantage members experience 45% lower out-of-pocket costs and have more than a 40% lower rate of avoidable hospitalizations and report a 96% satisfaction rating -- all at a lower cost to the Government," the insurer's statement read.

代表美国保险提供商的国家级行业协会和倡导团体美国健康保险计划(AHIP)的发言人克里斯·邦德在一份给美国广播公司新闻部的声明中表示:“医院垄断企业、品牌药物制造商以及某些有私募股权支持的医疗服务提供者,通过其持续的反竞争做法和过度的价格上涨,正在推高美国家庭和雇主的保费和自付费用。”

"Hospital monopolies, brand drugmakers and certain private equity-backed providers are driving up premiums and out-of-pocket costs for American families and employers through their consistent anticompetitive practices and excessive price hikes," Chris Bond, spokesperson for AHIP, a national trade association and advocacy group representing U.S. insurance providers, told ABC News in a statement.

邦德补充说:“健康计划正在竭尽全力帮助美国人免受成本不断上升的全面影响,但我们需要采取务实的、两党支持的改革措施来解决医疗负担能力危机。”

"Health plans are doing everything they can to help shield Americans from the full impact of rising costs, but commonsense, bipartisan reforms are needed to address the healthcare affordability crisis," Bond added.

代表生物制药研究和生物技术公司的行业协会美国药物研究与制造商协会(PhRMA)的副副总裁钱斯·琼斯在给美国广播公司新闻部的声明中表示,标价并未计入保险公司和药房福利管理者(PBM)从药物中获得的返利和折扣。

In a statement to ABC News, Chanse Jones, deputy vice president of PharmaceuticalResearch and Manufacturers of America (PhRMA), a trade association representing biopharmaceutical research and biotechnology companies, said that list prices do not account for rebates and discounts that insurers and pharmacy benefit mangers (PBM) receive on medications.

琼斯表示:“由于药品福利管理机构和保险公司的保险福利设计选择——例如处方集安排、分摊成本设计以及关于谈判节省下来的资金是否与患者分享的决定——患者往往无法直接从这些节省中受益,这些因素在决定患者自付医药费方面发挥着核心作用。”

"Patients do not often benefit directly from these savings due to the insurance benefit design choices of PBMs and insurers -- for example, formulary placement, cost-sharing design and decisions about whether negotiated savings are shared with patients -- which play a central role in determining what patients pay out of pocket for medicines," Jones said.

美国医院协会在给美国广播公司新闻部的声明中表示,它对医疗负担能力有着共同的担忧。该协会称,“隶属关系”可能包括兼并和收购,“有助于维持医院运营并保留全天候的医疗服务获取途径,特别是在农村和其他服务不足的社区”。

The American Hospital Association (AHA) told ABC News in a statement that it shares concerns about healthcare affordability. It said "affiliation," which may include mergers and acquisitions, "can help keep hospitals open and preserve 24/7 access to care, particularly in rural and other underserved communities."

美国医院协会的声明部分指出:“政策制定者和购买者应该关注企业型健康保险公司的整合与规模,其中许多公司名列财富500强榜单前列,并继续收购诊所。这些企业型保险公司的市场主导地位对医疗负担能力和医疗服务获取产生了负面影响。”关税推高了成本。这些专家告诉美国广播公司新闻部,在唐纳德·特朗普总统任内实施的关税是医疗成本增加的另一个近期原因。科莱特指出,这可能不是最大的因素。

"Policymakers and purchasers should focus on the consolidation and size of corporate health insurers, many of which sit atop the Fortune 500 list and continue to acquire physician practices," the AHA's statement said, in part. "The market dominance of these corporate insurers has had negative effects on affordability and access to care." Tariffs drive up costs These experts told ABC News that tariffs implemented under President Donald Trump are another recent reason healthcare costs have increased. Corlette noted that it may not be the biggest factor.

她说:“但它正在增加医院和其他医疗服务提供者必须采购和使用的商品及供应品的成本,这确实推高了医疗成本。”美国食品药品监督管理局估计,大约78%的活性药物成分制造商位于美国境外,进口产品占美国使用的大约一半医疗器械。

"But it is increasing the cost of goods and supplies that hospitals and other providers have to acquire and use, and that does drive up the cost of care," she said The Food and Drug Administration estimates about 78% of active pharmaceutical ingredient manufacturers are located outside the U.S. and imports account for nearly half of medical devices used in the U.S.

2026年10月26日,唐纳德·特朗普在密西西比州科林斯的十字路口竞技场举行的竞选集会上举起拳头。Dan Busey/The TimesDaily via APDonald Trump raises his fist during a campaign rally at Crossroads Arena in Corinth, Miss., Oct. 26, 2026. Dan Busey/The TimesDaily via AP

此外,医院和医疗系统依赖全球供应链来获取药品和原材料。接受美国广播公司新闻部采访的专家表示,采购成本的增加可能会导致患者承担更重的经济负担。

Additionally, hospitals and health systems depend on the global supply chain for pharmaceuticals and raw materials. Increases in procurement costs could lead to patients taking on a higher financial burden, according to experts who spoke with ABC News.

佐治亚理工学院经济学院与加州大学戴维斯分校今年发表的一项研究发现,联邦政府对进口医疗用品征收的关税在2025年前六个月总计达到34亿美元。

A study published this year from Georgia Tech's School of Economics and the University of California, Davis found that the federal government's tariffs on imported medical supplies totaled $3.4 billion in the first six months of 2025.

根据佐治亚理工学院的一份新闻稿,其中超过一半(近56%)以更高价格的形式转嫁给了医疗机构、供应商以及“潜在的消费者”。

Of that amount, more than half -- nearly 56% -- was passed on to medical facilities, providers and "potentially consumers in the form of higher prices," according to a press release from Georgia Tech.

库珀表示:“任何面临关税且进入护理生产过程的产品都变得更加昂贵。这最终推高了护理成本和保险费。”特朗普曾多次为本届政府的关税辩护,并一度对因关税导致价格上涨的担忧不以为然。

"Anything that's facing a tariff that goes into the care production process has become more expensive," Cooper said. "That ends up ultimately raising the cost of care and insurance premiums." Trump has defended his administration's tariffs on a number of occasions and, at times, has dismissed concerns about higher prices due to tariffs.

白宫女发言人艾莉森·舒斯特在给美国广播公司新闻的一份声明中表示,特朗普政府的最惠国待遇(MFN)药品定价协议——该协议将美国处方药价格与同类发达国家支付的相同药物最低价格挂钩——已为美国人节省了超过10亿美元。

White House spokeswoman Allison Schuster told ABC News in a statement that the Trump administration's most favored nation (MFN) drug pricing agreements -- which link the price of prescription drugs in the U.S. to the lowest prices paid for the same medications in other comparable, developed nations -- have saved Americans more than $1 billion.

舒斯特的声明接着说:“随着全美50个州、华盛顿特区和波多黎各加入‘慷慨’模式,在医疗补助计划(Medicaid)中提供最惠国待遇药品定价,这些协议正推动几十年来最大幅度的药品价格下降。白宫将继续与国会合作,通过总统的‘伟大医疗计划’,将他的最惠国待遇协议成文立法,并为普通患者扩大药品价格节省。”GLP-1价格标签专家告诉美国广播公司新闻,近期医疗保健成本上升的另一个原因是GLP-1使用量的增加,这是一种用于2型糖尿病和减重的热门药物。

"With all 50 states, Washington D.C., and Puerto Ricog onto the GENEROUS model to provide MFN drug pricing on Medicaid, these deals are driving the biggest drop in drug prices in decades," Schuster's statement continued. "The White House continues to work with Congress to pass the President’s Great Healthcare Plan to codify his Most Favored Nations deals and expand drug pricing savings for everyday patients." GLP-1 price tag Another reason for recent rising healthcare costs is the increased use of GLP-1s, the popular medications used for type 2 diabetes and weight loss, experts told ABC News.

自2014年第一款药物获得食品药品监督管理局批准以来,GLP-1在减重方面的使用量有了显着增加,在Wegovy于2021年和Zepbound于2023年获批后更是如此。

There has been a noticeable increase in the use of GLP-1s for weight loss since the first medication received approval from the Food and Drug Administration in 2014, and even more so following approval of Wegovy in 2021 and Zepbound in 2023.

根据盖洛普新闻7月的一项民意调查,目前大约有11%的美国成年人专门为了减重而服用GLP-1药物,高于2024年的3%。

About 11% of U.S. adults currently take GLP-1 medications specifically for weight loss, up from 3% in 2024, according to a Gallup News poll in July.

随着越来越多的人服用这些药物,在这方面的支出也在增加。2025年,《美国医学会杂志·网络开放版》发表的一封研究信发现,2018年至2023年间,GLP-1药物的支出增长了500%以上,从137亿美元增至717亿美元。

As more people take the drugs, more money is being spent on them. In 2025. a research letter published in JAMA Network Open found that spending on GLP-1s rose by more than 500% between 2018 and 2023, from $13.7 billion to $71.7 billion.

司美格鲁肽注射笔的库存图片。Iuliia Burmistrova/STOCK PHOTO/Getty ImagesStock photo of a Semaglutide injection pen. Iuliia Burmistrova/STOCK PHOTO/Getty Images

对于患者来说,这些品牌药物通常每月花费超过1000美元。美国卫生系统药师协会(ASHP)的数据显示,相应地,GLP-1药物约占2025年美国处方药总支出的14%。

The brand-name drugs typically cost more than $1,000 a month for patients. In turn, GLP-1 drugs made up about 14% of all U.S. prescription drug spending in 2025, according to the ASHP.

美国卫生系统药师协会关于2025年美国处方药支出的报告发现,这一支出在很大程度上是由GLP-1药物驱动的。替尔泊肽(tirzepatide)和司美格鲁肽(semaglutide)的支出各自约为600亿美元。相比之下,排名第三的处方药——血液稀释剂阿哌沙班(apixaban)的支出为29亿美元。

ASHP's report on U.S. prescription drug spending in 2025 found that it was largely driven by GLP-1s. About $60 billion was spent on tirzepatide and semaglutide each. By comparison, $29 billion was spent on the third-highest prescription, apixaban, a blood thinner.

凯撒家庭基金会(KFF)今年的一项调查发现,在提供员工保险计划的公司中,对用于减重的GLP-1药物的报销范围有限,大约只有五分之一的大公司这样做。然而,大多数将减重药纳入报销范围的公司将其对处方药支出的影响描述为“显著”(29%)或“中等”(27%)。

KFF's survey from this year found there was limited coverage for GLP-1s for weight loss on employer insurance plans with only about one in five large companies doing so. However, most companies covering weight loss drugs described their impact on prescription drug spending as "significant" (29%) or "moderate" (27%).

凯撒家庭基金会医疗保健市场项目副主任马修·雷当时对美国广播公司新闻(ABC News)表示:“在GLP-1上的高额支出通常会推高整体保费。”库珀表示,与其他处方药类似,美国人要等到仿制版GLP-1药物上市,才能指望看到价格下降。

Matthew Rae, associate director of the healthcare marketplace program at KFF, told ABC News at the time that "high spending on GLP-1s can generally increase premiums overall." Similar to other prescription drugs, Cooper said it will take the availability of generic GLP-1s for Americans before they can expect to see prices come down.

他说:“我认为,基本上从现在到GLP-1出现仿制药竞争的这段时间里,我们将一直在努力解决如何负担得起它们的问题。所以大约是在2030年。因此,在第一款GLP-1仿制药上市之前,我们还有大约三、四年时间,在这期间我们不得不应对这些产品非常、非常高的价格。”

"I think there's basically the period between now and when GLP-1s see generic competition that we're [going to] be wrestling with how to afford them," he said. "So that's about 2030. And so, we have sort of three or four years here before the first GLP-1 generic comes online where we're going to have to wrestle with the very, very high prices for these products."

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