The federal government has a new suggestion for patients facing crushing out-of-pocket medical costs: borrow the money from their health insurance company, according to a report in yesterday’s New York Times. Tucked inside a 1,121-page final rule governing how the Affordable Care Act marketplace will operate next year, the Trump administration is encouraging insurers to consider offering loans to enrollees who face large bills before hitting their deductibles.
For the credit and collection industry, the proposal represents a potentially significant shift in where medical debt originates and who holds it. Rather than unpaid balances flowing from hospitals and physician groups to revenue cycle firms and collection agencies, insurers themselves could become creditors, originating debt at the point of care and presumably charging interest on repayment.
The idea arrives as more than a third of American households already carry some form of medical debt, and as ACA plan costs climb following the expiration of enhanced federal subsidies. Average marketplace premiums have jumped to $178 a month this year from $113 in 2025, according to KFF, while average deductibles now approach $4,000 per person. The new rule also expands access to catastrophic plans, with family deductibles eventually allowed to exceed $31,000.
Among the experts quoted in the NYT report were: a spokesman for the Centers for Medicare and Medicaid Services, who said the loan concept would let patients spread out payments on large bills incurred before reaching their deductible; and a Republican healthcare consultant who described the lending option as a workaround for the high cost of marketplace plans. The report noted that at least one carrier, UnitedHealth Group, already operates a bank through its Optum unit and is structurally positioned to lend, though the company declined to say whether it would.
Skeptics quoted by the NYT were not convinced the model solves anything. A Stanford economist called the approach out of touch with household finances, and a University of Washington researcher noted that insurer lending simply restructures who patients owe rather than addressing underlying costs. Research from Johns Hopkins has consistently shown that consumers carrying medical debt are more likely to delay or forgo care entirely, a dynamic familiar to anyone working accounts in the healthcare receivables space.
