Why Black Paychecks Are About To Shrink As Health Care Costs Surge

Health insurance premiums are already climbing, insurers have locked in higher 2026 rates, and the enhanced Affordable Care Act subsidies that have kept coverage affordable for millions are set to expire on Thursday, Jan. 1, 2026. 

The increases are no longer hypothetical. They are visible now, baked into open enrollment, and poised to accelerate in the coming year. For many workers, this won’t just show up as a higher monthly bill. It will show up directly in their paychecks, as employers shift rising health care costs onto employees through higher premium contributions, reduced benefits, and slower wage growth. 

Policymakers and insurers insist this will affect “everyone.” Middle-class families of all races are struggling. And that is true. But it is also incomplete because the early evidence shows the burden will fall hardest on Black families and businesses.

The American health care system likes to present itself as colorblind, clinical, and mathematical. It is largely driven by data, risk pools, utilization rates, and actuarial tables that supposedly strip emotion and politics out of life-and-death decisions. We are told that rising premiums are unfortunate but inevitable, that the healthcare system is strained, and that nobody is being unfairly targeted. 

The math is supposedly mathing. 

But this is America, where numbers don’t float above history or erase bias. What recent reporting on rising health care costs reveals, often without fully naming, is that the healthcare system is engineered to convert racialized harm into predictable revenue that disproportionately falls on Black folks.

A JAMA report has shown that overall costs are higher for Black and Latino households, with Black families often paying more out-of-pocket for care and insurance even as they face systemic barriers to access. Another analysis from the Economic Policy Institute argues that proposals to end Affordable Care Act tax credits will hit Black Americans especially hard. In 10 major metropolitan areas, such changes could leave over 170,000 people without insurance, drive up annual premiums by roughly $740 million, and increase preventable deaths. Healthcare Finance has noted that premium increases are outpacing wage growth, with Black and Hispanic workers feeling those pressures acutely. 

These reports describe outcomes such as higher costs, lost coverage, sticker shock, and preventable deaths, but they stop short of naming who benefits and why the system keeps producing the same racialized harm on schedule. Readers are left with the sense that this is unfortunate, cyclical, or merely a matter of policy negligence, rather than the predictable result of an industry engineered to extract wealth from people least able to absorb it.

What’s happening with healthcare in our current moment did not emerge from recent policy shifts, but rather a century-long continuum of racialized medical extraction, exclusion, and pricing. It’s connected to redlining’s impact on hospital access, employer-based insurance as a Jim Crow labor workaround, and desegregation, which triggered white flight from public health infrastructure. Without that context, Black folks appear as perpetual victims of “rising costs,” rather than communities that have been systematically positioned to subsidize everybody else’s care through higher premiums, worse coverage, and delayed treatment.

And there’s corporate culpability. Insurers, pharmaceutical companies, hospital conglomerates, private equity firms, and consulting giants appear as abstractions in these reports. There’s no sustained interrogation of pricing algorithms, risk scoring, provider consolidation, or shareholder expectations. These are mechanisms that quietly convert Black illness into revenue. And they are the result of deliberate choices by specific lawmakers responding to donors and industry pressure.

These stories also don’t fully explore how constant cost anxiety reshapes medical decision-making in Black households. People skip care, delay prescriptions, ration insulin, avoid emergency rooms, and choose debt over diagnosis. That stress is a health condition in itself, one that compounds hypertension, heart disease, pregnancy outcomes, and mortality. The body is paying interest on policy.

At the end of the day, Black people are not just a disproportionately affected group, but they are the financial backbone of the healthcare system. Black families aren’t just harmed by rising costs. They are overpaying into a system that routinely underserves them. That inversion matters. Without it, these stories document injustice but don’t fully expose exploitation.

Black illness, stress, exposure, deprivation, and Black survival itself are not aberrations to the model. They are inputs. They are priced in. And as health care costs rise, Black people will be disproportionately extracted from, disciplined by, and charged for injuries they did not choose and cannot escape.

The key mechanism is risk. Health insurers and employer-sponsored plans calculate premiums using formulas that rely heavily on past utilization: how often people seek care, what diagnoses they carry, what medications they take, how frequently they are hospitalized, and how expensive their treatment histories appear on paper. In theory, this is efficient. In practice, it quietly transforms structural violence into individual liability.

Black Americans have higher rates of chronic illnesses like diabetes, hypertension, asthma, heart disease, autoimmune disorders, and pregnancy-related complications. That fact is endlessly cited, rarely contextualized, and almost never treated as an indictment of the racist system that produced it. Instead, those outcomes are fed into algorithms that conclude Black people are “higher risk,” and therefore more expensive to insure.

The system does not ask why those conditions are concentrated where they are. It does not account for food apartheid, in which fresh food is scarce and ultraprocessed calories are abundant. It does not code for neighborhoods built next to highways, refineries, waste sites, and industrial corridors where asthma and cancer rates soar. It does not adjust for generations of redlining that stripped wealth, limited housing options, and destabilized community infrastructure. It does not quantify the physiological toll of racism itself, the daily stress, hypervigilance, discrimination, and trauma that drive inflammation, cardiovascular strain, immune dysfunction, and premature aging.

Those harms are invisible to the spreadsheet. Their biological consequences are not.

Epigenetics makes this even harder to deny. Chronic stress, malnutrition, environmental toxins, and violence do not just shape individual health outcomes. They also alter gene expression across generations. The bodies of Black Americans are carrying the biological residue of centuries of slavery, of Jim Crow terror, and policies and conditions imposed long before any individual health plan was selected. Yet insurers treat those embodied histories as present-day risk factors rather than as inherited evidence of harm. And so racialized intergenerational trauma becomes an actuarial justification, and racism becomes a surcharge.

This is where people often interject: rising health care costs affect everyone. Premiums are going up across the board. 

What distinguishes Black Americans is not merely that costs are rising, but how those costs are calculated, absorbed, and compounded. Black workers are more likely to earn less, hold less wealth, and have fewer financial buffers to absorb premium hikes, deductibles, and out-of-pocket expenses. Paying more for health care means sacrificing something else like rent, food, utilities, and debt payments in ways that accelerate harm rather than simply inconvenience.

Black Americans are also more likely to be insured through jobs that offer fewer plan options, higher employee contributions, narrower networks, and less employer subsidization. When premiums rise, employers often pass those costs on to employees. Insurers point to utilization. Employers point to insurers. Policymakers point to market forces. Responsibility dissolves at every handoff, while Black workers pay more to remain insured.

And then there is how Black people must use health care once they have it. Delayed care is common not because of ignorance, but because of cost, access barriers, and mistrust born of lived experience. When care is delayed, conditions worsen. When conditions worsen, treatment becomes more expensive. When treatment becomes more expensive, utilization rises. When utilization rises, premiums increase. This is not a coincidence. It is a feedback loop.

The system punishes Black people for surviving within conditions it refuses to change.

Meanwhile, Black patients are still more likely to be undertreated, disbelieved, misdiagnosed, or dismissed by medical professionals. Pain is minimized. Symptoms are attributed to lifestyle or attitude. Preventive care is harder to access, and specialty care often requires navigating referral systems that were not designed with Black patients in mind. So Black Americans are paying more into a system that delivers less, later, and often with worse outcomes.

This is what makes the claims of universality misleading. Yes, rising costs affect everyone. But not everyone is being charged for injuries inflicted by the same system that collects the premiums. Not everyone’s illness is treated as both inevitable and profitable. Not everyone is positioned as a permanent high-risk category with no meaningful pathway out.

For white Americans, increased health care costs are often experienced as economic pressure layered onto otherwise protected status. For Black Americans, they are experienced as a continuation of historical extraction, and are another mechanism through which harm is monetized and normalized.

And as policy decisions loom, such as the expiration of ACA tax credits, the consequences will not fall evenly. Losing subsidies does not simply mean paying more. It means losing coverage altogether for people already operating at the margins. It means preventable deaths framed as unfortunate trade-offs. It means the quiet resegregation of health care access under the language of fiscal responsibility.

Systems do not drift into these outcomes accidentally. They are designed through policy choices, market incentives, corporate consolidation, and regulatory frameworks that prioritize profitability over repair.

Insurers are not simply reacting to Black illness; they are profiting from its predictability. Pharmaceutical pricing strategies, hospital mergers, private equity ownership of clinics, and data-driven risk scoring all depend on stable patterns of chronic disease. Black communities, made vulnerable through deliberate neglect, provide that stability. A system that ignores race while feeding on racialized outcomes is extractive. It takes what racism has produced and converts it into revenue streams, shareholder value, and balance-sheet logic.

And this is why incremental reforms feel so inadequate. Lowering premiums slightly does not dismantle the algorithm. Expanding access without changing pricing logic simply widens the pool of people being charged for harm. Diversity statements do nothing to alter risk models. Cultural competence training does not rewrite actuarial tables.

To confront this honestly requires naming what the system is doing, which is charging Black folks for surviving racism, then using their survival as proof that higher costs are justified.

SEE ALSO:

ACA Open Enrollment Reveals Increase In Monthly Premiums

Obtaining ACA Insurance Is Expensive, Complex, And Maddening