The health care affordability crisis is not new to us. But a bold new proposal could be a game-changer.
If you’ve ever sat in a doctor’s office and wondered if your insurance will cover what you need, you’re not alone. Nearly half of adults in this country say it is difficult to afford health care. A third say they had to skip or delay care because of cost. And for black women, who already navigate a system that has historically undervalued, underdiagnosed, and undertreated them, the financial burden of health care isn’t just an inconvenience. It can be the difference between life and death.
A new report from the Center for American Progress, Bill of Rights for Lower Health Care Costslays out a bold, concrete set of proposals to lower premiums, reduce deductibles and end the practice of prior authorization that forces patients to fight their insurance companies for care their doctors have already deemed necessary. At the Black Women’s Health Imperative, we believe this conversation is one that Black women cannot afford to sit out. We’ve read it and here’s what you need to know.
The numbers tell a story
The average family premium for employer coverage is now about $27,000 a year, with families paying nearly $7,000 of that out of pocket. Over the past decade, discounts have more than doubled in many markets. Nearly one in three workers now has a deductible of $2,000 or more.
These are not abstract statistics. It’s the reason black women delay cancer screening. It’s the reason a mother chooses between her blood pressure medication and her child’s school supplies. It is why the maternal mortality crisis is not addressed at the individual level, even when we know there are clinical solutions.
Our National Health Policy Agenda 2025-2026 makes it clear that access to quality, affordable healthcare is the foundation of everything else. You can’t deal with maternal health, chronic disease, reproductive justice or HIV if people can’t afford to walk through the door.
What does the Report suggest?
The CAP report outlines four key areas of reform:
- Limiting excessive premium increases. The proposal requires that premium increases above the increase in actual medical costs be considered excessive and require justification. In states where this standard would have been implemented in 2025, individuals could have seen their premiums drop by an average of $415.
- Reduction of discounts by limiting extreme hospital prices. Some hospitals charge commercial insurers more than three times what Medicare pays for the same services. The report suggests limiting these prices to concentrated markets, with savings passed directly to patients in the form of lower rebates. The estimated average reduction for workers in affected markets is $933.
- Preventing insurance companies from raising prices. Health insurance markets are among the most concentrated industries in the country. The report recommends delinking insurers’ profits from premiums and spending levels, so that insurers can’t quietly boost their profits simply by increasing what they charge and what they pay. Discounts will be returned to enrollees when insurers exceed the benchmark.
- No Prior Authorization. This one hits close to home. Prior authorization is the process by which insurance companies require your doctor to get approval before you can receive care. It was originally designed as a narrow tool. Today it has become a general obstacle. Physicians complete an average of 39 prior authorizations per week, covering nearly two full business days. Studies show that in Medicare Advantage, 95% of prior authorization requests are ultimately approved, meaning the vast majority of delays and denials are simply unnecessary.
The report recommends replacing prior authorization with evidence-based independent clinical review, removing insurance company bureaucrats from the exam room, and returning medical decisions to physicians.
Because this matters to black women
At BWHI, Pillar I of our National Health Policy Agenda is dedicated to Access to Quality and Affordable Health Care. This is not a regional concern. It is the foundation upon which all our other work rests.
Black women are disproportionately enrolled in Medicaid, which has already absorbed brutal cuts under the One Big Beautiful Bill signed into law last year. These cuts, including new work requirements, more frequent eligibility redeterminations and mandatory co-pays, have pushed hundreds of thousands of black women out of coverage or on the brink of losing it. For those who remain in the private insurance markets, the dynamics described in the CAP report hit our community with particular force.
Black women are more likely to hold jobs without paid time off, assume primary caregiving responsibilities, and live farther from health care facilities. We are more likely to have conditions such as fibroids, lupus, diabetes and hypertension that require regular specialist care and ongoing medication. These are exactly the kinds of circumstances that prior authorization delays and disrupts most often.
“When we talk about health care affordability, we’re not talking about suffering. We’re talking about a structural barrier that determines whether Black women live or die,” said Ifeoma C. Udoh, Ph.D., Executive Vice President of Policy and Research at the Black Women’s Health Imperative. “Every dollar a black woman spends fighting a prior denial or trying to cover a $2,000 deductible before she can see a specialist is a dollar stolen from her health, her family, and her future. These reforms would go a long way toward dismantling a system that was never designed with her in mind.”
The bigger picture
We want to be clear: a patients’ bill of rights is no substitute for the deeper structural reforms our communities need. We still need Medicaid expansion in every state. We still need the Hyde Amendment repealed. We still need comprehensive postpartum coverage as a national standard, Medicaid reimbursement for doulas and midwives, and real investment in the perinatal workforce. These battles continue and BWHI is not backing down from any of them.
But the CAP report reflects something important: bold, short-term action is possible. We don’t have to wait years for systemic reform to lower costs for people who are struggling right now. High price review works. Hospital price caps work. Eliminating prior authorization would remove one of the most burdensome and arbitrary barriers to the health care system. These are not radical ideas. They are practical tools with a history.
Black women have always been asked to wait. Be patient. Be thankful for incremental progress. We’re done waiting. Our health is too urgent, our lives too precious, and our community too organized to accept anything less than the full range of reforms our families deserve.
Read the full report from the Center for American Progress:
Bill of Rights for Lower Health Care Costs
Read BWHI’s National Health Policy Agenda 2025-2026 at bwhi.org
