One Utah woman who recently learned that her family’s Affordable Care Act (ACA) plan would increase by over 300 percent next year, amounting to over $2,100 per month in premiums, described the increase as “devastating.”

Millions of Americans on the ACA marketplace are now facing such bank-breaking health care costs after Republicans failed to renew pandemic-era extended insurance tax credits. Without these subsidies, premium payments are expected to more than double in 2026 — all while the country’s top insurers enjoy billions in profits and executive compensation packages.

Despite the 2010 passage of the Affordable Care Act, US health care spending is as bloated as ever, with consumers paying the price: Families now contribute nearly $7,000 a year to employer-sponsored plans on average, up 23 percent from just five years ago.

Despite recent industry hand-wringing about profitability, since 2010, the five largest health insurers have boosted their annual profits by 230 percent, with more than 40 percent of that going to UnitedHealth Group alone. This is, in part, due to industry consolidation: The nation’s top insurers are actually subsidiaries of vertically integrated megaconglomerates with multiple streams of revenue.

Those profits are delivering extravagant C-suite rewards. UnitedHealth Group CEO Andrew Witty, the industry’s top-earning executive, took home $26 million in compensation last year, a nearly 12 percent increase over 2023. This includes $1.5 million in salary, $1.5 million in revenue-tied cash bonuses, and $22 million in stock options.

Then there’s Gail Boudreaux, CEO and president of Elevance Health (formerly Anthem), a health insurance industry veteran who has also been an executive at Aetna, BlueCross BlueShield, and UnitedHealth Group. In 2024, Boudreaux was paid over $20 million, including a $1.6 million salary, $1.1 million in performance bonuses, and $16 million in stock.

Meanwhile, these companies have poured hundreds of billions of dollars into stock buybacks and dividend payouts, enriching executives and other top shareholders. For example, Cigna, which reported nearly $2 billion in net income in the most recent quarter, has been on a stock buyback tear, resulting in over $10 billion in planned returns for top investors. So far this year, Elevance Health has already committed $3.3 billion to shareholder payouts through buybacks and dividends.

The companies have been generous in Washington too. UnitedHealth Group, Elevance Health, Centene, Humana, and Aetna have together spent nearly $36 million this year seeking to influence the Trump administration and Congress.