“Health insurance in America is very expensive, because health care is very expensive,” said Katherine Baicker, a health economist who is the provost at the University of Chicago. “And that’s true in every market. What’s different is who is writing the check, and how easily perceived the full cost is to the individual who is being insured.”

Many states have shown rising premiums ahead of open enrollment for Affordable Care Act plans. The government shutdown is driven by Democrats and Republicans being far apart on the issue of extended subsidies.

Larger employers typically offer a higher floor for coverage, but smaller firms are more likely to pay employee premiums in full.

Experts attribute the increase to chronic diseases, which lead to large, long-term costs, the lack of price control on pharmaceutical pricing, and industry consolidation, especially among pharmacies, which eliminates competition and makes it difficult to hold down costs.