Texas 2036 says pricing, not usage, is driving higher health costs

Texas 2036 released a four-report series Tuesday arguing that market dynamics and billing practices are pushing healthcare prices higher across Texas. The findings land as families face nearly $27,000 in annual employer-sponsored premiums and widespread concern about affordability.

Why it matters: - Texas families with employer-sponsored coverage now pay nearly $27,000 a year in premiums. - 63% of Texans with employer-sponsored coverage have delayed or skipped care in the past year because of cost. - Nearly 9 in 10 Texans said they are concerned about healthcare affordability in a June 2026 Texas Politics Project poll. - Texas 2036 says the report series identifies policy changes that could improve competition, transparency and accountability in healthcare markets.

What happened: - Texas 2036 released Symptoms of an Unhealthy Market, a four-report series on July 21, 2026. - The series examines what is driving healthcare prices higher in Texas and what policymakers can do about it. - The organization said the core finding is that prices, not increased use of care, remain the main driver of healthcare spending. - The full report series is available here.

The details: - Prices Versus Utilization: It's Still the Prices says billing changes, not greater use of care, explain much of what patients pay. - U.S. healthcare spending reached $5.3 trillion in 2024, equal to nearly 18% of the national economy. - The share of office and emergency room visits billed at the highest complexity level rose from 31% to 43% between 2012 and 2023. - Texas 2036 said that increase did not come with a corresponding rise in patients getting sicker. - Understanding Facility Fees says facility-fee billing is reducing transparency, raising the price of routine care and creating unexpected charges for Texans. - A primary care visit that averages $116 in a physician’s office costs $217 in a hospital outpatient department. - Texas 2036 cited one Texas family whose routine pediatric visit rose from $90 to nearly $600 after the clinic was acquired by a hospital system. - Hospital Consolidation in Texas says shrinking competition among hospitals is associated with higher prices. - 69% of hospitals now belong to a larger health system, up from 56% in 2010. - In nearly half of U.S. metro areas, 47%, just one or two health systems control the inpatient market. - Nine Texas metro areas, including Amarillo, Corpus Christi and Laredo, are served by only one or two health systems. - The True Cost of Dispute Resolution examines the rising cost of the arbitration system used to resolve surprise medical billing disputes. - Arbitration and mediation requests to the Texas Department of Insurance grew from about 49,000 in 2020 to more than 519,000 in 2023. - Health plans and providers have paid more than $121 million in arbitrator and mediator fees since 2020. - Average provider-billed amounts in arbitration cases rose sixfold to $18,577.

Between the lines: - Texas 2036 is framing healthcare affordability as a market-structure problem, not just a utilization problem. - The report series points to billing practices, consolidation and dispute-resolution costs as pressure points that can raise prices without improving care. - Alec Mendoza, policy advisor for health and economic mobility at Texas 2036 and report author, said many of the biggest drivers of higher prices happen through market dynamics that patients rarely see. - Mendoza also said the Legislature has options to make markets more informed, competitive and accountable.

What's next: - Texas 2036 is urging state policymakers to consider reforms that could lower costs for families, employers and taxpayers. - The organization says the findings are meant to inform legislative action on affordability in the next policy cycle.

The bottom line: - Texas 2036’s message is blunt: healthcare costs are rising because the market is broken in ways most patients never see.