What’s driving up healthcare costs?
Healthcare costs

What’s driving up healthcare costs?

It’s not just more care. It’s more complex care.

  • Stefanie Abate
  • Jul 1, 2026

As healthcare prices skyrocket, we must work together to bring the costs under control

In an op-ed published by The Boston Globe, BCBSRI President & CEO Martha L. Wofford calls for renewing enhanced federal premium tax credits, describes how soaring healthcare costs are driving up health insurance premiums, and discusses ways Rhode Islanders can work together to improve healthcare affordability, access, and quality.

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Please note that you may need a Boston Globe subscription to access the article.

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Behind the numbers

Healthcare is complicated. These graphics help explain what’s driving up the cost of your care.

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Nearly all of our members’ premiums are spent on healthcare

As a nonprofit health insurer, BCBSRI estimates 87% of premiums will be enough to pay for our members’ healthcare services. In recent years, those costs have been significantly higher than expected, with over 91% of premiums going to pay claims.

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Nearly all of our members’ premiums are spent on healthcare

As a nonprofit health insurer, BCBSRI estimates 87% of premiums will be enough to pay for our members’ healthcare services. In recent years, those costs have been significantly higher than expected, with over 91% of premiums going to pay claims.

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Find out why healthcare costs are rising—and what we can do together to improve access to high-quality, affordable care.

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Real solutions for Rhode Islanders

To address this crisis, we must keep working together as a state to balance affordability for Rhode Islanders with stability for our healthcare system. Here's how we're working to improve access to high-quality, affordable care—and how you can help.

Stethoscope icon graphic Improving access to high-quality, cost-effective primary care in RI

BCBSRI has invested $500 million in RI’s primary care practices since 2014 and has also:

  • Increased payments to primary care providers for our fully insured commercial plans by 35%, as mandated by the Office of the Health Commissioner’s (OHIC’s) updated affordability standards
  • Voluntarily eliminated most primary care medical prior authorizations for both Commercial and Medicare plans, which will help create additional capacity for more patients to be seen
  • Offered a new provider contract option that provides monthly payments to PCPs to improve financial stability and predictability to support staff hiring and expanded patient access
Blood transfusion icon graphic Helping members get proactive care to improve their health and reduce costs

BCBSRI is offering comprehensive support to our members, including:

  • Providing personalized care navigation assistance to improve member benefit utilization and help empower more informed healthcare decisions through BlueCare Connect, our unique member support solution
  • Launching targeted programs—including for cancer, behavioral health, and kidney disease—to proactively help members improve their health, reduce costly emergency room and hospital visits, and keep care local
  • Encouraging members to access $0 preventive care, including well visits and cancer screenings, to help them stay healthier and find health issues in earlier, more treatable stages
Rx bottle icon graphic Delivering more ways to lower Rx drug cost

We’re focused on strategies that help members get the medication they need at a cost they can afford, including:

  • Partnering with Blue Cross Blue Shield companies to collectively negotiate lower prices on high-cost specialty drugs through Synergie Medication Collaborative1 and to manufacture lower cost generic medications through CivicaScript2
  • Shifting to biosimilar and generic medications that offer comparable quality at significantly lower costs
  • Working with local health systems to deliver specialty drugs, which saves money, helps patients get drugs faster, and provides crucial revenue to local providers
Scale icon graphic Improving our operating efficiency to lower administrative costs

While operating expenses are a small percentage of premiums, every dollar saved helps mitigate premium increases and supports the sustainability of our healthcare system. In 2025, BCBSRI saved $20 million by:

  • Consolidating vendor contracts
  • Deploying technologies for greater efficiency
  • Reducing our workforce with a focus on leadership roles
Legislative building icon graphic Learn how you can make a difference

Improving the affordability of healthcare will take all of us, working together. Here’s how you can help:

  • Stay informed on proposed healthcare legislation and how it could impact you and/or your business
  • Support lower premium growth by opposing legislative/regulatory mandates that would increase healthcare costs
  • Continue to represent your employees’ or constituents’ needs and protect them from premium cost increases that could result from new coverage mandates

1Synergie Medication Collective℠ is an independent entity owned by a group of Blue Cross and Blue Shield affiliated companies.

2Civica Rx is an independent company partnering with Blue Cross & Blue Shield of Rhode Island and other Blue Cross and Blue Shield companies to provide select generic drugs to members.