Under Healthcare ‘Dystopia’ Envisioned by Trump, Cash-Strapped Patients Would Take Out Loans From Insurers
“This could ruin people’s finances, while creating a financial incentive for insurers to deny coverage,” said one Democratic congresswoman.
A medical billing statement showing a past due amount.
(Photo by Getty Images)
Julia Conley
Jun 12, 2026
COMMON DREAMS
After the Republican Party’s decision to terminate subsidies that had significantly reduced healthcare costs under the Affordable Care Act for 22 million people, the White House is considering a new way to—officials claim—“help” Americans who face massive medical bills, either due to high-deductible plans that don’t cover routine costs or because of emergency expenses.
The proposal, though, could just shift “who [the patients] owe the debt to,” as one doctor and researcher told The New York Times, which reported Thursday on the Trump administration’s proposal to allow people to take out loans directly from their health insurance companies when they can’t afford to pay a hospital or doctor’s office out of pocket—and then pay the insurance company back, likely with interest.
“Hard to top this level of dystopia,” said one writer in response to the Times report. “Have health insurance through the ACA? The Trump administration is going to turn your health insurer into a loan shark you borrow money from if you can’t afford to pay your portion of medical procedures.”
As the newspaper was reported, the provision is buried in a 1,121-page final rule issued last month regarding how the ACA will be regulated next year.
The Trump administration is planning to significantly expand the number of Americans who are eligible for high-deductible “catastrophic” health insurance plans that provide no coverage for day-to-day medical expenses.
“We note that multiyear and 1-year catastrophic plans may be able to offer relief from the high deductible and maximum annual limitation on cost sharing through other mechanisms,” reads the final rule. “For example, issuers of catastrophic plans could consider financing the deductible by providing enrollees a loan.”
Currently, the average annual deductible for people insured under the ACA is nearly $4,000, and about 40% of enrollees this year have “Bronze” plans, which have an out-of-pocket maximum that’s over $10,000 for an individual, likely leaving many people having to pay thousands of dollars in medical expenses despite having coverage.
By 2028, as Common Dreams reported earlier this year, catastrophic plans with lower premiums could have deductibles as high as $31,000 for families.
The plan to shift more people onto expensive plans that provide less coverage for day-to-day medical care—and to push patients to take out loans from their insurers—comes as about one-third of Americans, even those with insurance, report skipping meals or cutting back on other expenses to afford their medical bills.
The Times reported that at least one major health insurer—UnitedHealthcare, the nation’s largest—is already equipped to start lending patients money to cover unexpected medical bills. The company operates a bank that administers loans to doctors and offers health savings accounts.
Rep. Shontel Brown (D-Ohio) said the latest proposal from the White House shows that President Donald Trump “is destroying healthcare from all sides.”
The advocacy group Protect Our Care said the “suggestion” buried in the Centers for Medicare & Medicaid Services’ final rule “is not only out of touch, it is cruel—accruing medical debt only adds to families’ financial burdens.”
“While working families drown in the high cost of living, the Trump administration’s answer to the healthcare affordability crisis they created is to throw people an anchor made of medical debt and call it relief,” said Leslie Dach, chair of Protect Our Care. “Trump and Republicans had a simple, popular fix sitting right in front of their faces—extending the ACA tax credits—but they killed it anyway, triggering premiums to double, triple, or even quadruple for millions of working families, all to make billionaires and big corporations even richer.”
“Americans are being bankrupted by crushing medical debt, and this administration isn’t lifting a finger to help—it’s busy shoveling more people into that hole,” said Dach. “Voters will remember this foolishness at the ballot box in November, just you wait.”
Melanie D’Arrigo, executive director of the Campaign for New York Health, which advocates for a universal, single-payer healthcare system for New York state, suggested the proposal makes the latest case for a federal, government-funded healthcare program similar to those in other wealthy countries, which would end the healthcare profit motive by expanding the existing Medicare system to the entire US population.
“Letting Americans take out loans to afford healthcare forces Americans deeper into debt and drives up profits for the health insurance industry,” said D’Arrigo. “Abolish the health insurance industry. Demand Medicare for All.”
Court Blocks ‘Illegal’ Trump Rule That Created Barriers to Affordable Care Act Coverage“This could ruin people’s finances, while creating a financial incentive for insurers to deny coverage,” said one Democratic congresswoman.
A medical billing statement showing a past due amount.
(Photo by Getty Images)
Julia Conley
Jun 12, 2026
COMMON DREAMS
After the Republican Party’s decision to terminate subsidies that had significantly reduced healthcare costs under the Affordable Care Act for 22 million people, the White House is considering a new way to—officials claim—“help” Americans who face massive medical bills, either due to high-deductible plans that don’t cover routine costs or because of emergency expenses.
The proposal, though, could just shift “who [the patients] owe the debt to,” as one doctor and researcher told The New York Times, which reported Thursday on the Trump administration’s proposal to allow people to take out loans directly from their health insurance companies when they can’t afford to pay a hospital or doctor’s office out of pocket—and then pay the insurance company back, likely with interest.
“Hard to top this level of dystopia,” said one writer in response to the Times report. “Have health insurance through the ACA? The Trump administration is going to turn your health insurer into a loan shark you borrow money from if you can’t afford to pay your portion of medical procedures.”
As the newspaper was reported, the provision is buried in a 1,121-page final rule issued last month regarding how the ACA will be regulated next year.
The Trump administration is planning to significantly expand the number of Americans who are eligible for high-deductible “catastrophic” health insurance plans that provide no coverage for day-to-day medical expenses.
“We note that multiyear and 1-year catastrophic plans may be able to offer relief from the high deductible and maximum annual limitation on cost sharing through other mechanisms,” reads the final rule. “For example, issuers of catastrophic plans could consider financing the deductible by providing enrollees a loan.”
Currently, the average annual deductible for people insured under the ACA is nearly $4,000, and about 40% of enrollees this year have “Bronze” plans, which have an out-of-pocket maximum that’s over $10,000 for an individual, likely leaving many people having to pay thousands of dollars in medical expenses despite having coverage.
By 2028, as Common Dreams reported earlier this year, catastrophic plans with lower premiums could have deductibles as high as $31,000 for families.
The plan to shift more people onto expensive plans that provide less coverage for day-to-day medical care—and to push patients to take out loans from their insurers—comes as about one-third of Americans, even those with insurance, report skipping meals or cutting back on other expenses to afford their medical bills.
The Times reported that at least one major health insurer—UnitedHealthcare, the nation’s largest—is already equipped to start lending patients money to cover unexpected medical bills. The company operates a bank that administers loans to doctors and offers health savings accounts.
Rep. Shontel Brown (D-Ohio) said the latest proposal from the White House shows that President Donald Trump “is destroying healthcare from all sides.”
The advocacy group Protect Our Care said the “suggestion” buried in the Centers for Medicare & Medicaid Services’ final rule “is not only out of touch, it is cruel—accruing medical debt only adds to families’ financial burdens.”
“While working families drown in the high cost of living, the Trump administration’s answer to the healthcare affordability crisis they created is to throw people an anchor made of medical debt and call it relief,” said Leslie Dach, chair of Protect Our Care. “Trump and Republicans had a simple, popular fix sitting right in front of their faces—extending the ACA tax credits—but they killed it anyway, triggering premiums to double, triple, or even quadruple for millions of working families, all to make billionaires and big corporations even richer.”
“Americans are being bankrupted by crushing medical debt, and this administration isn’t lifting a finger to help—it’s busy shoveling more people into that hole,” said Dach. “Voters will remember this foolishness at the ballot box in November, just you wait.”
Melanie D’Arrigo, executive director of the Campaign for New York Health, which advocates for a universal, single-payer healthcare system for New York state, suggested the proposal makes the latest case for a federal, government-funded healthcare program similar to those in other wealthy countries, which would end the healthcare profit motive by expanding the existing Medicare system to the entire US population.
“Letting Americans take out loans to afford healthcare forces Americans deeper into debt and drives up profits for the health insurance industry,” said D’Arrigo. “Abolish the health insurance industry. Demand Medicare for All.”
With eligibility verification and fees, the rule was projected to force 2 million people to drop their insurance, said cities and advocacy groups that sued the administration.
A. Michael Khoury stands outside of his Leading Insurance Agency, which offers plans under the Affordable Care Act, on January 28, 2021 in Miami, Florida.
(Photo by Joe Raedle/Getty Images)
Julia Conley
Jun 12, 2026
COMMON DREAMS
Officials in several cities joined advocacy groups in celebrating a federal court ruling Friday that blocked the Trump administration’s rule which, they argued in a lawsuit, illegally imposed new fees and created barriers “that would make it harder—and in some cases impossible—for people to get and keep affordable health insurance.”
The cities of Columbus, Ohio; Baltimore; and Chicago were among the plaintiffs in a case filed last week in the US District Court of Maryland against Health and Human Services Secretary Robert F. Kennedy and other Trump officials, arguing that the so-called “Marketplace Integrity and Affordability” rule would destabilize the insurance market and penalize vulnerable families, “rather than promoting affordability.”
The rule was introduced in May, months after Affordable Care Act subsidies that had made ACA insurance premiums more affordable for millions of people were allowed to expire by Republicans in Congress. More than 1 million fewer Americans signed up for coverage in ACA exchanges after the tax credits expired, and the Trump administration claimed that the new rule’s provision of more “catastrophic” insurance plans would give more “choice” to people who couldn’t afford plans that cover more healthcare needs.
The rule also required additional verification for low-income households before they enroll in ACA plans, with Centers for Medicare and Medicaid Services Administrator Mehmet Oz claiming the new requirement “strengthens eligibility checks, cracks down on abuse, and gives insurers more flexibility to offer affordable, consumer-focused coverage options.”
“Cloaked in the pretense of government efficiency and fraud prevention, the 2026 rule creates numerous barriers to affordable insurance coverage.”
The verification requirements and new fees could cause as many as 2 million people to drop their coverage, said Democracy Forward, which represented the plaintiffs, as well as raising annual costs by about $700 for families.
“Cloaked in the pretense of government efficiency and fraud prevention, the 2026 rule creates numerous barriers to affordable insurance coverage, negating the ACA’s goal of extending affordable health coverage to all Americans, and instead increasing the population of underinsured and uninsured Americans,” the plaintiffs said in the lawsuit.
In the ruling on Friday, US District Judge Brendan Hurson vacated several provisions of the rule, including ones that revoked guaranteed insurance coverage for people with past-due premiums; required eligibility verification for the special ACA enrollment period; and imposed a $5 premium penalty on people who automatically reenrolled in their plans.
Columbus City Attorney Zach Klein said the rule’s provisions were among “the Trump-Vance administration’s illegal attempts to undermine the Affordable Care Act.”
“This ruling is a significant win for millions of Americans, including thousands in Ohio, who would have been denied coverage or seen their out-of-pocket costs skyrocket due to this president and his administration,” said Klein. “We will continue to fight to protect healthcare coverage for all Americans whenever it’s threatened.”
Richard Trent, executive director of Main Street Alliance, a small business advocacy group that also joined the lawsuit, said that “the Trump-Vance administration’s unlawful attempt to undermine the Affordable Care Act would have increased costs, created unnecessary barriers to coverage, and made it harder for entrepreneurs and workers to get the care they need.”
“Small business owners cannot grow their businesses when healthcare becomes more expensive and less accessible,” said Trent. “We are grateful that the court has protected these critical safeguards and reaffirmed that affordable healthcare remains essential to a strong economy and thriving Main Streets across the country.”
Baltimore Mayor Brandon Scott also applauded the ruling, but emphasized that healthcare advocates’ “work is not over.”
As Common Dreams reported Friday, tied up in the Trump administration’s push for more Americans to use high-deductible catastrophic insurance—which is likely to present families with high out-of-pocket costs—is a plan to push households into more medical debt by allowing them to take out loans directly from their health insurance companies.
“We will continue to fight back against any attempts by this administration to slash protections under the ACA,” said Scott, “and will not stop fighting until every person in this nation has access to the affordable, quality healthcare they deserve.”
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