Chronic Disease is Straining U.S. Health Care, and Insurers Aren’t Helping

Chronic conditions are the primary driver of rising U.S. health care spending across Medicare, Medicaid and private insurance, a new study from the Partnership to Fight Chronic Disease (PFCD) detailed last week. Costs are highly concentrated among patients living with three or more chronic conditions, and obesity plays a central role.

PFCD Chair Kenneth Thorpe, PhD., and Peter Joski authored the new research report, which is particularly relevant leading up to two House hearings this Thursday.

If chronic disease is the cost driver, insurance companies might be the engine.

Five CEOs from large insurance companies are scheduled to meet first with the Committee on Energy and Commerce and then the Committee on Ways and Means. The largest U.S. insurance companies have vertically integrated into health care conglomerates that repeatedly prioritize profits over patients. This has led to a system that struggles to deliver timely, affordable treatment to Americans.

About 60% of U.S adults live with at least one chronic condition, and 20% have multiple. The study uncovered how increased spending is linked to an increase in the number of patients with multiple chronic conditions, highlighting how per-person plan spending for privately insured patients with three or more chronic conditions rose 31% from 2011 to 2022. These patients comprise 27% of private-insurance patients but nearly 60% of category spending.

In 2022, chronic disease accounted for 93% of Medicare spending and 82% of Medicaid spending. Meanwhile, the Centers for Medicare and Medicaid Services (CMS) announced last week that national health expenditures increased by 7.2% in 2024, following a 7.2% surge in 2023. At $5.3 trillion, health care consumed a staggering 18% share of GDP in 2024.

About four in 10 American adults have obesity. Among Medicaid beneficiaries managing four or more chronic conditions, more than half have obesity.

The research makes clear that slowing unsustainable spending growth requires preventing the onset and progression of chronic disease, addressing obesity as a chronic illness, and improving care coordination. Meanwhile, many health experts observe an insurance marketplace that appears to be moving in the opposite direction.

Rather than support prevention and better disease management, insurers are increasingly focused on maximizing profits through evolving formulary and utilization management practices that consolidate market power and slow access to necessary care.

Insurers now own pharmacy benefit managers, provider groups, group purchasing organizations, and health systems. UnitedHealthcare alone operates nearly 2,700 subsidiaries.

Insurance decision-making has shifted from patient-centered to business-centered. Utilization management, prior authorization requirements, and formulary restrictions routinely delay or deny medically necessary care. Rather than staying focused on delivering life-altering treatment, physicians are forced to navigate step therapy limitations, insurance denials, and other red tape. This leaves chronic disease patients waiting for approvals while their health deteriorates, ultimately leading to costly medical care and preventable hospitalizations.

Congressional lawmakers should consider how current insurance practices are fueling increased costs throughout the health care system by ignoring the patients themselves and how they access the treatments and resources their physician recommends.