By Christopher Johnson, President & CEO
If it feels like everything is getting more expensive right now, you’re not alone — and you’re not wrong.
Families and congregations are navigating rising costs across the board, from groceries to housing to gas prices that have climbed in recent months. At the same time, health care costs have been steadily rising for years, with more pronounced increases following the pandemic.1
Health care is part of this broader reality, but it often stands apart as one of the most significant — and least predictable — expenses people face.
Health care costs aren’t rising for just one reason — and there’s no single solution. But understanding cost drivers can help individuals and employers make more informed, sustainable choices about care.
A Decade of Rising Costs
Over the past several years, health care spending in the United States has grown steadily, often outpacing inflation. Total national health expenditures now exceed $5 trillion annually — accounting for nearly one-fifth of the entire U.S. economy — and continue to rise.2
What has changed more recently is the pace and visibility of these increases. Following the pandemic, demand for care rebounded as people returned for services they had delayed. At the same time, providers experienced higher operating costs — including labor and supplies — which continues to put upward pressure on spending. 1, 2
What’s Accelerating Cost Increases Today?
Several forces are working together to drive rising health care costs even higher today. One of the most significant drivers is price, particularly for hospital care, physician services, and prescription drugs.3
Health care is a labor‑intensive industry, and workforce costs now account for more than half of hospital expenses.4
At the same time, the cost of drugs and medical supplies has grown significantly, adding meaningful pressure to the cost of care.4
To help clarify how this shows up in practice, Portico’s Head of Products, Laura Weiglein, explains:
“In many cases, the care itself hasn’t changed dramatically, but the price attached to it has. For example, the MRI you receive in 2026 may be the same technologically and procedurally as it was in 2024 or 2025, but the price for that same scan can increase from one year to the next — in some cases by around 5–7%.”
In addition to higher input costs, providers are caring for patients who are sicker and require more complex treatment, which increases the cost of delivering care.4
Innovation is also a key factor. New therapies, particularly specialty medications, offer meaningful clinical benefits but often come with high price tags.5 As these innovations become more widely used, they add to overall system costs. Weiglein notes:
“We’re benefiting from incredible advancements in medicine — but progress isn’t free.”
Understanding Price vs. Volume
Health care costs are driven by two key factors: price and volume. Price reflects what is paid for services, while volume reflects how often services are used.
For many years, higher prices have been the primary driver of cost growth in the United States, meaning the same services are costing more over time.3 More recently, utilization has also increased as people returned for care they delayed during the pandemic.1
When both prices and usage rise at the same time, costs accelerate — and that impact is felt by both employers and individuals. Employers see higher overall claims and contribution rates, while members experience higher premiums, deductibles, and out-of-pocket costs.1, 3
How Group Health Plans Work — and Why Trends Matter
Many employer-sponsored plans, including Portico’s ELCA Health Plan, operate as self-insured group plans. In this model, contributions are pooled to pay for health care claims across the covered community.6
This shared structure helps spread risk and provide stability, which is critical in helping our faith community sustain affordable costs and provide equitable coverage to rostered ministers across the country. But it also means rising costs are experienced collectively.
Some of the most significant pressures facing the ELCA Health Plan in recent years have included brand-name and specialty medications — particularly GLP-1s — along with inpatient medical and surgical services, where costs have risen sharply.
Complex care can add pressure as well. ELCA Health Plan claims data shows higher claims related to cancer and musculoskeletal conditions, both of which can become significant cost drivers in a shared plan. They often involve specialized treatment, surgery, or ongoing care, including services such as cancer treatment, knee or hip replacement, and spine surgery.
For ELCA Health Plan members, that makes these national trends tangible — they directly influence contribution rates and the long-term sustainability of the plan.6 At the same time, the community-based model helps provide access to benefits and support that would be more difficult to secure individually or in smaller groups.
What Value Really Means in a Health Plan
When people compare health coverage, it is natural to focus first on the sticker price — the monthly premium or, as we call it, contribution. But value is broader than that. It includes deductibles, out-of-pocket costs, provider access, covered services, continuity of care, and the support people receive in navigating the system.3
Some plans may offer lower premiums in the short term, but those options can involve tradeoffs — including higher deductibles, limited provider networks and formularies, or reduced continuity when moving between regions.7, 8
For ELCA Health Plan members, value is shaped by a community-based model that provides stability across calls and geographic moves, along with support beyond the core medical benefit.6 The plan is designed not only to pay claims, but to support access, stability, and whole-person well-being over time.
Taken together, these elements are why conversations about health coverage increasingly focus on value — not just cost alone.
Portico’s Role in Managing Costs Responsibly
Portico serves the ELCA as both a ministry and a benefits provider. Our responsibility is to balance meaningful access to care with long-term sustainability.
That means actively managing cost drivers within the ELCA Health Plan — helping members make informed decisions, supporting care coordination, and designing benefits that encourage high-value care.6 It also means making thoughtful choices about how the plan evolves over time while preserving flexibility, stability, and access for the whole community. A continued focus on growth is part of that work, helping maintain a strong, diverse risk pool and the economies of scale that support more stable costs across the plan.
Because the ELCA Health Plan is built on a shared model, these efforts are not just about controlling costs but are about stewarding resources in a way that sustains care for today while protecting the plan for the future.
Laura Weiglein’s team is focused on managing these pressures thoughtfully and proactively:
“We are constantly looking for ways to reduce unnecessary cost inside the plan while protecting the care our members count on.”
Looking Ahead
Health care costs are expected to continue rising due to ongoing pressures related to pricing, utilization, and innovation.5
While specific drivers may shift over time, the broader pattern is likely to continue. Advances in treatment will improve outcomes but often come with higher price tags, even as demand for care evolves and provider pressures persist.
For employers, health plans, and individuals alike, this means focusing on understanding these dynamics and making informed decisions about how to manage costs while maintaining access to care.
A Shared Understanding and a Shared Path
Health care costs can feel overwhelming, but they reflect a system that continues to evolve — shaped by more complex care needs, new treatments, and the realities of how care is delivered and financed.
For members of the ELCA Health Plan, this is something experienced together. The shared nature of the plan means that both challenges and solutions are part of a broader community.
This work is not new for us. It is rooted in a long Lutheran tradition of caring for one another — a belief that well-being is not an individual burden, but a shared responsibility. For generations, faith communities have come together to support one another in times of need, reflecting values that reach back to our earliest foundations as a nation and a church. That same spirit lives on in how we approach benefits today. At its heart, this is about more than cost or coverage — it is about people. It is about ensuring that those who serve are cared for, that communities remain strong, and that no one carries these challenges alone.
In the ELCA, stewardship is something we share. Together, we can approach these challenges with clarity, compassion, and a shared commitment to sustaining community care for the long term.
About the Author
Christopher (Chris) Johnson is President and CEO of Portico Benefit Services, where he leads the organization’s work to provide retirement, health, and whole-person wellness benefits as a ministry of the Evangelical Lutheran Church in America (ELCA). With more than 30 years of experience in financial services, health care, and consulting, he brings deep expertise in leading growth-focused, member-centered organizations. Prior to joining Portico, Chris held leadership roles at Elevance Health, UnitedHealth Group, U.S. Bancorp, and American Express. He earned bachelor’s degrees in economics and business management from the University of North Dakota and a Master of Business Administration from the Carlson School of Management at the University of Minnesota. Chris serves on the boards of the Church Alliance, Church Benefits Association, and the University of North Dakota’s Center for Innovation. A lifelong Lutheran, Chris and his family are members of Trinity Lutheran Church in Stillwater, Minnesota.
1 Peterson-KFF Health System Tracker, How Has U.S. Spending on Health Care Changed Over Time? (January 22, 2026), including related analysis of post pandemic utilization and spending growth.
2 Centers for Medicare & Medicaid Services (CMS), National Health Expenditure Accounts (NHEA) Data, 2024 release.
3 KFF, Health Care Costs and Affordability; Peterson-KFF Health System Tracker analyses of health spending drivers.
4 American Hospital Association, Cost of Caring: Drivers of Health Care Costs (2025–2026).
5 PwC Health Research Institute, Medical Cost Trend: Behind the Numbers 2026–2027.
6 ELCA Medical and Dental Benefits Plan, 2026 Plan Document (self-insured plan structure and administration).
7 HealthCare.gov, How to Report a Move to the Marketplace (guidance on state-based coverage transitions).
8 KFF, Deductibles in ACA Marketplace Plans (2014–2026) and 2026 Marketplace Cost Trends.