Rising healthcare bills are weighing on voters ahead of the midterms. What’s fueling the surge?

With Americans heading to the polls in the midterm elections, climbing healthcare expenses are among the biggest financial and economic worries, according to recent surveys.

In a KFF poll released earlier this month, one-quarter of voters said they were very worried about affording healthcare costs, while more than one-third said they were somewhat worried.

For people who buy coverage through the Affordable Care Act marketplace, the average monthly benchmark premium rose from $497 in 2025 to $625 in 2026, KFF said, with the increase coming after enhanced premium tax credits expired at the end of last year.

KFF also reported in a recent analysis that finalized benchmark silver premiums under the ACA are expected to increase by an average of 13% next year, the second straight year of double-digit gains.

People with employer-based insurance are seeing higher costs too. A new KFF survey found workers are paying nearly 10% more for premiums.

The average deductible for single coverage has also climbed sharply, rising 43% since 2015 to $1,886 in 2025, according to KFF.

Prescription drug spending increased 12.7% in 2025 to $915 billion and is projected to top $1 trillion in 2026, according to the American Society of Health-System Pharmacists.

An AARP Public Policy Institute report this year found that the top 25 brand-name drugs have risen in price by an average of 81% since entering the U.S. market.

While higher premiums and prescription costs are major contributors, experts say they are only part of the story. Many Americans are facing sticker shock, and some healthcare and economic policy specialists say several factors are pushing costs higher, with relief unlikely to come quickly.

“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 and founder and co-director of the Center on Health Insurance Reforms at Georgetown University McCourt School of Public Policy, told ABC News.

Corlette said she is worried prices could keep rising in the years ahead.

“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 healthcare costs have been climbing recently.

Greater use of AI

Experts told ABC News that more providers, including hospitals and doctors' offices, are using ambient artificial intelligence scribes to document visits, review lab results and draft medical notes to reduce paperwork for physicians.

Insurance companies such as Blue Cross Blue Shield and healthcare analytics firms such as Trilliant Health have suggested these tools may be contributing to secondary diagnoses or to a mismatch between the care patients receive and the bills sent to insurers.

“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.

Cooper said some AI tools may be pushing patients into higher billing categories.

Corlette described a personal example in which she went to a doctor for an annual checkup and was charged a copay for the first time.

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

When Corlette called the office to ask about the copay, she was told, “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,” she 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 said. “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 copay.

She said AI may raise claims costs for insurers, though it remains unclear what the long-term effect on overall healthcare spending will be.

She also noted that insurers have faced accusations of using AI to deny care or coverage. In November 2023, a lawsuit was filed against UnitedHealthcare alleging one of its subsidiaries denied post-acute care claims using an artificial intelligence program without human review. The case is still pending.

UnitedHealthcare told ABC News its “predict tool” is not used to make adverse coverage decisions, but instead provides information to families, caregivers and providers about the 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.

A 2024 Senate subcommittee report also found that denial rates for post-acute care in Humana and UnitedHealthcare Medicare Advantage plans, as well as post-acute requests subject to prior authorization for CVS, increased significantly after greater use of automated tools, predictive technologies or AI.

CVS said in a statement that it has invested in AI and other technologies to streamline processes and improve the experience for patients, providers and employees.

“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.

UnitedHealthcare also said the report “mischaracterizes the Medicare Advantage program and our clinical practices,” and ignored Centers for Medicare & Medicaid Services criteria 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 company said.

Chris Bond, a spokesperson for AHIP, the national trade association and advocacy group for U.S. health insurers, said in a statement that hospital monopolies, brand-name drugmakers and some private equity-backed providers are pushing up premiums and out-of-pocket costs through anticompetitive practices and excessive price increases.

“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 said.

Chanse Jones, deputy vice president of Pharmaceutical Research and Manufacturers of America (PhRMA), said in a statement that list prices do not reflect rebates and discounts insurers and pharmacy benefit managers receive on medications.

“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.

The American Hospital Association said it shares concerns about affordability. In a statement, it said “affiliation,” which can include mergers and acquisitions, can help keep hospitals open and preserve 24/7 access to care, especially in rural and other underserved communities.

“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 said. “The market dominance of these corporate insurers has had negative effects on affordability and access to care.”

Tariffs pushing up prices

Experts also said tariffs imposed under President Donald Trump are a recent reason healthcare costs have gone up, though Corlette said they may not be the largest factor.

“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 that about 78% of active pharmaceutical ingredient manufacturers are located outside the U.S., and imports account for nearly half of the medical devices used in the country.

Hospitals and health systems also rely on the global supply chain for pharmaceuticals and raw materials. Higher procurement costs can leave patients with a larger financial burden, according to experts who spoke with ABC News.

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

More than half of that amount, nearly 56%, was passed on to medical facilities, providers and “potentially consumers in the form of higher prices,” Georgia Tech said in a press release.

“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 repeatedly defended his administration's tariffs and has sometimes dismissed concerns that they raise prices.

In a statement to ABC News, White House spokeswoman Allison Schuster said the administration's most favored nation drug-pricing agreements, which tie U.S. prescription drug prices to the lowest prices paid for the same medications in other comparable developed countries, have saved Americans more than $1 billion.

“With all 50 states, Washington D.C., and Puerto Rico signing onto the GENEROUS model to provide MFN drug pricing on Medicaid, these deals are driving the biggest drop in drug prices in decades,” Schuster said. “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 costs

Another factor behind recent healthcare inflation is the growing use of GLP-1 medications, the widely used drugs for type 2 diabetes and weight loss, experts told ABC News.

Use of GLP-1s for weight loss has grown noticeably since the first drug in the class was approved by the Food and Drug Administration in 2014, and more sharply after Wegovy was approved in 2021 and Zepbound in 2023.

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

As more people take the drugs, spending has surged. A research letter published in JAMA Network Open in 2025 found GLP-1 spending climbed by more than 500% between 2018 and 2023, from $13.7 billion to $71.7 billion.

These brand-name medications often cost more than $1,000 a month for patients. In 2025, GLP-1s accounted for about 14% of all U.S. prescription drug spending, according to ASHP.

ASHP's report on 2025 U.S. drug spending said GLP-1s were a major driver. Roughly $60 billion was spent on tirzepatide and semaglutide each, compared with $29 billion for the third-highest prescription, apixaban, a blood thinner.

KFF found in a survey this year that coverage for GLP-1s for weight loss remained limited on employer plans, with only about one in five large companies offering it. Among companies that do cover the drugs, most described the effect on prescription spending as significant or moderate.

Matthew Rae, associate director of KFF's healthcare marketplace program, told ABC News at the time that high GLP-1 spending can generally push premiums higher overall.

Cooper said lower prices are unlikely until generic versions become available.

“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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