4 min read
Imagine millions of customers waking up to a bill twice as large for the same cover. That possibility is not hypothetical; it is a realistic scenario for many in the United States in 2026, and it has direct implications for insurers worldwide. Rising premiums will reshape consumer behaviour, regulatory scrutiny and competitive dynamics. For international insurers, the answer is not just price-setting but transforming operations so they remain competitive, compliant and customer-centric.
Background
Several converging forces are pushing premiums higher. In the US, a key driver is the potential expiry of enhanced Affordable Care Act premium tax credits. Independent analyses warn that if these subsidies lapse, average premium payments for many marketplace enrollees could more than double next year, resulting in steep sticker shock for approximately 20 million people who currently rely on enhanced support. At the same time, insurers are already requesting significant rate increases for 2026 to reflect rising underlying healthcare costs, including hospital services, labour inflation and the growing use of high-cost speciality drugs such as GLP-1s for diabetes and obesity, which further pulls premiums upward. Beyond the US, many markets face similar upward pressure as ageing populations, new therapies, and post-pandemic utilisation trends raise claim costs. Exchange rates, supply-chain disruptions for pharmaceuticals and heightened regulatory capital requirements in some jurisdictions add another layer of cost that insurers must price into products. The upshot is a global context in which premiums are climbing, risk pools are shifting, and affordability is becoming a regulatory and reputational risk for any carrier operating internationally.
Operational optimisation is the strategic lever insurers need
Faced with external cost inflation and political uncertainty, insurers cannot win on price alone. Operational optimisation offers a sustainable way to protect margins, keep products affordable and improve customer experience. Automation and lean process design reduce friction and cost across the policy lifecycle, from marketing and sales to policy administration and claims. Conversational Process Automation platforms, for example, those used in regulated industries, can handle high-value customer interactions 24/7 while ensuring compliance, speeding up onboarding, increasing straight-through processing and lowering call centre pressure. This reduces unit costs and creates the headroom insurers need to absorb some medical inflation without immediately passing the full burden to customers.
Optimising operations also directly improves risk selection and retention. Faster, cleaner data flows enable real-time underwriting adjustments, more accurate pricing for subsegments and proactive customer engagement that prevents lapses. Digital automation reduces human error, accelerates claims adjudication and uncovers fraud patterns earlier. In a world where an abrupt policy change, such as the withdrawal of subsidies, can erode enrollee mixes and increase adverse selection, the carrier that is leaner and more agile will be better positioned to adjust product design, target communication, and manage churn. Operational resilience becomes a competitive moat, not merely an internal efficiency target.
Technology cannot substitute for macro policies and clinical cost drivers
It is essential to acknowledge the limits of operational fixes. No amount of process efficiency will fully offset broad macroeconomic and policy-driven cost increases. If premium tax credits disappear or if significant new drugs materially increase claims costs, the resulting higher base cost of healthcare will need to be reflected in premiums unless governments or suppliers change behaviour. Critics are right to point out that digitalisation can introduce its own costs, implementation, legacy integration and regulatory compliance, and that poor execution risks alienating customers who are not digitally native. Moreover, operational optimisation addresses supply-side efficiency but does not directly reduce the price of hospital stays, specialist procedures or patented drugs.
However, the counter-argument should not be an excuse for inaction. The cost of doing nothing is material: slower claims handling, higher churn, regulatory fines and reputational damage as customers seek alternatives. Thoughtful automation programmes are not technology for technology’s sake. When designed for regulated businesses, they prioritise audit trails, security, and human oversight where clinical judgement or consumer vulnerability is involved. Platforms that deliver compliant self-service, faster straight-through processing, and integrated partner chains reduce operational drag and free up capital for more strategic uses, such as product innovation, targeted subsidies, or value-based care partnerships. In short, while automation does not eliminate macro cost pressures, it significantly increases an insurer’s optionality and response speed.
Conclusion
Premiums are rising, and in the US, the possibility that many households could see payments more than double in 2026 if policy support lapses is a wake-up call for insurers everywhere. The market will not wait for perfect policy solutions. International insurers operating across multiple regulatory regimes must therefore focus on two concurrent tracks: engage with policymakers and health systems to mitigate systemic cost drivers, and accelerate operational transformation to protect customers and margins. Optimising operations through lean processes, data integrity, and compliant automation is not a one-off project but a strategic capability that shapes pricing flexibility, customer trust and regulatory standing. Platforms that specialise in conversational process automation and claims straight-through processing can be powerful allies in this journey, offering regulated businesses the compliance, security and scale required to act quickly and responsibly.
For professionals in regulated businesses, the message is clear. Prepare for a higher-cost environment by reducing internal friction, improving data quality and deploying automation where it protects the customer experience and regulatory compliance. The insurers that do so will be the ones who can compete not just on price, but on resilience and speed, the real differentiators in a turbulent 2026.
