Have we decided health is a perk?

We had to buy a new car recently. Living in Center City — where our cars are constantly outside, parked on far-flung streets, easily dinged — I neither need nor want top-of-the-line status symbols.

The car we were replacing had been part of the family since 2008, and finally gave out. As with any major purchase, I started car shopping by determining what was in our budget.

Confession: I’m boring and basic with personal finances. I live within my means, which is living within my earnings. Any monthly payment has to fit into that and still allow for savings. We don’t live large, but we live well. This formula works for me.

Well, this formula works for everything other than healthcare.

On Nov. 1, insurance costs for 2026 became public. The $2,800 monthly premium made “living within my means” feel meaningless.

Healthcare is the only major “essential expense” we can’t predict or plan for — even though our health is the foundation of the quality and length of our lives. The only other expense that comes close is my home mortgage.

The federal government was shut down for the longest period in history. One of the sticking points was on the Affordable Care Act’s marketplace medical insurance subsidies. The basic question: Is the U.S. government responsible for making health insurance affordable for people who pay for it themselves?

In America, the main doorway to access medical care is through a job. Employer-sponsored health insurance covers 60% of people in the U.S. under age 65, nearly half of whom are kids and family (dependents).

But even with a job, health insurance isn’t automatically included. KFF did an analysis that illustrates the variation and disparity in access to insurance through employers. For our region, annual salary ranges for 200% to 400% of the federal poverty level for a family of my size are $65,000 to $184,000. Low-income earners and people working for small companies or independent businesses are less likely to get medical insurance through their employers.

A year ago, the Biden administration invited me to the White House as part of its Cancer Moonshot. I was the physician representing my company alongside 29 other organizations, accounting for 6.5 million workers across the country, mostly represented by their HR benefits managers.

It was the first time I realized how much benefits decision-makers impact the access, quality, and ease of healthcare.

The people in the room were the ones who made foundational health decisions for their workers: Would they get insurance coverage? What kind? And how much would they pay out of pocket for it? This group determined access to care for millions.

In the U.S., health insurance — and therefore healthcare — seems to be treated like a perk. It’s not unlike PTO days, on-site daycare, and discounts to Disney World. In this case, the better the job, the better supported you are to address chronic disease, screen early for cancer, access medications, or get checkups for your kids.

That is, until a year like 2025 comes along.

U.S. employers have announced over one million job cuts in 2025, with more than 150,000 in October alone. By early August, 2025 had surpassed COVID-19 as the period of most layoffs. Entire companies have crumbled in our region, like Rite Aid pharmacies. Even the “recession-proof” healthcare industry has faltered — from full destruction, as in Crozer Chester, to reductions in force at Jefferson and Tower Health.

Government and tech workers alone accounted for nearly 450,000 job losses. And that doesn’t include the government employees who were in limbo during the shutdown.

With job loss, there are few options other than to continue health coverage through COBRA access — a federal act that allows employees to keep their group coverage for a period of time at a cost of up to 102% of the total premiums.

During COVID, unemployed people had access to Medicaid, especially in expansion states like Pennsylvania. But in 2025, Medicaid eligibility requirements are far more stringent. In our state, more than 300,000 people are at risk of losing Medicaid coverage next year.

The Affordable Care Act was, in part, designed for those people who don’t meet the criteria for Medicaid or Medicare, who also do not get insurance through their employer.

When car shopping, I wasn’t interested in paying more for bells, whistles, or special paint colors, but I would absolutely pay for more safety and protection. Somehow, approaching health insurance with the same mentality feels like I’m being extorted.

For both my house and my cars, someone at a bank decided I could absorb the expense spread out over years. For health insurance, the sentiment seems to be: “That’s on you. Good luck!”

The annual premiums for a family of four are basically like paying for a new car every year — not just any car, but a midsize SUV. And that’s just what it costs to have insurance — it doesn’t include the deductible paid before the insurance kicks in, or the coinsurance afterward. No wonder medical expenses have been the leading cause of personal bankruptcy in the U.S. for years.

Will we hold our leaders accountable to figure it out? Is this the reckoning we need to rein in healthcare expenses?

Healthcare is complex, convoluted, and deeply anchored in historic practice and policy. But sustainable improvement will continue to elude us until we at least agree on the purpose of healthcare and drive to realize it.

I believe it’s to keep people well — to work, to live, to grow old, to thrive. A healthy and productive citizenry helps our country, economy, and future.

In the decades I’ve been working in the emergency department, I’ve understood the common denominator of every patient or family who comes to us for help is not medical — it’s fear and uncertainty. They are asking for help to keep their most important possession — their loved ones — safe.

If the chaos of this moment leads to change, I hope it includes this conclusion: Our health has never been a luxury perk. We must do what we can to protect it instead of taking it for granted. But we should also fight for reasonable access to the services and systems that can help keep us safe, healthy, and well.

Priya E. Mammen is an emergency physician, healthcare executive, and public health specialist who helps the nation’s most impactful companies integrate clinical integrity at scale.