Millions of Americans are likely experiencing sticker shock as they learn that their monthly health insurance bills are set to skyrocket next year. Much of the blame has focused on the likely expiration of enhanced premium tax credits, which will drive up rates for Affordable Care Act Marketplace plans.

But this development isn’t the only culprit for our current health insurance crisis. After all, those with employer-sponsored coverage are also facing major insurance price hikes. In truth, experts say this moment has been decades in the making, fueled by lax oversight of health care consolidation that has given hospitals and health insurers enormous market power — and the freedom to keep raising prices.

“It’s definitely not debated that the reason why health care in this country costs more is because we let pharmaceutical companies and hospitals set the prices that they want to set,” said Claire Heyison, a senior policy analyst at the Center on Budget and Policy Priorities, a nonpartisan institute that analyzes federal and state budget policies.