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The high cost of healthcare has become one of the top issues on the campaign trail ahead of the 2026 midterms. As far as small businesses are concerned, the debate is welcome: Small Business Majority's research found 89 percent of small businesses said their health insurance premiums had increased this year.
Although solutions to rising costs have been discussed, some are more promising than others. One idea that would not help small businesses is a recent Trump regulation that offered more debt as a solution to rising medical expenses. The proposed rule would allow health insurance companies to offer loans to Affordable Care Act enrollees to cover their share of a medical bill.
Unfortunately, medical emergencies threaten more than an entrepreneur's health: they can also destabilize their business. When the bills start piling up, small-business owners are often forced to drain their personal and business savings. Medical debt can become a trap that threatens to close a business' doors when the owner needs its revenue the most.
We see this firsthand with entrepreneurs like Shayai Lucero of New Mexico. After suffering a heart attack, she had to be airlifted from a rural area to Albuquerque to receive life-saving care. While her insurance covered most of the bill, Shayai still had to pay out-of-pocket costs before leaving the hospital.
This unexpected expense consumed her profits for months. Other medical emergencies also posed financial burdens. After missing the busiest season for her floral business during another hospital stay, Shayai used her business line of credit to pay some medical expenses while losing revenue. To stabilize her business afterward, she took out an emergency loan that she is still paying off.
While Shayai's loan kept her doors open, it was a last resort.
Rising premiums in the ACA Marketplace, which have accelerated after the expiration of its enhanced premium tax credits, often leave small-business owners with no choice but to select plans with lower premiums but much higher deductibles.
With a whopping 37 percent increase in the average ACA Marketplace plan deductible this year, entrepreneurs will now be on the hook for even more money when they have a medical emergency. Under the Trump proposal, the same insurers profiting from high-deductible plans would also profit by collecting interest from enrollees' medical loans. This conflict of interest could easily trap small-business owners in a cycle of debt that would harm their personal and business finances.
Instead, federal policymakers have better alternatives to loans if they want to address healthcare affordability. Bipartisan legislation such as the Patients Deserve Price Tags Act and the Break Up Big Medicine Act would increase transparency in hospital pricing and reduce consolidation in care providers. When small-business owners know how much a medical procedure would cost, they could then shop around for care and make an informed choice. Transparency would also pressure medical providers to lower prices to stay competitive.
Meanwhile, hospital mergers have resulted in estimated associated price increases ranging from 3 percent to 65 percent. By prohibiting parent companies from owning both medical providers and pharmacy benefit managers or insurers, these firms wouldn't own both the providers that set care prices and the company that pays for care. This would prevent them from steering patients to their own network and inflating prices without competitive pressure.
These bills wouldn't directly eliminate medical debt, but lower healthcare costs would reduce debt for entrepreneurs in the first place. Ahead of a new Congress, members need to consider bold policy changes that would put the United States on par with the kind of affordable healthcare available in most other highly developed countries. The status quo isn't working for entrepreneurs, and federal policymakers must get to the root of the problem by addressing the underlying causes making healthcare so expensive in America.
This is a better approach than allowing insurers to become lenders and profit from the costs they're supposed to cover. Borrowing more money isn't a solution to medical debt, and entrepreneurs can't afford to wait. We urge the administration and Congress to pursue real solutions that lower healthcare costs for small businesses.
Alexis D'Amato Falvey is Small Business Majority's senior director of federal government affairs. She wrote this for InsideSources.com.