Employer health costs are set to jump the most since 2003—and even health care workers are struggling to afford care

When Americans break a bone, get sick, or need help in an emergency—health care workers are there ready to help.

But when they need care themselves, some health care workers are struggling to afford it, leading them to put off checkups, drop benefits, or even go without insurance.

Medical practices face the affordability crisis from both sides: they provide health care to Americans, but they are also employers that help pay for their workers’ coverage.

Rising premiums are forcing some independent practices to have to reconsider how much they can absorb, how much employees must pay, and whether they can continue offering insurance in itself at all.

Jack Dillon, executive director of the Association for Independent Medicine, told Fortune he has heard more concern about insurance costs this year than in a long time.

His own practice faced a 22.5% increase, forcing it to choose between taking on the added expense and raising employees’ share of their premiums.

“It’s a bigger struggle this year that I’ve heard than in previous years, and it’s getting louder and louder,” Dillon said.

This kind of pressure extends beyond medical practices.

More than 165 million Americans rely on employer-sponsored health coverage, but it’s getting more expensive for employers to provide.

Health benefit costs per employee are expected to jump 8.2% in 2027 , the steepest increase since 2003 and the fifth consecutive year of elevated growth, according to a Mercer survey of 1,800 employers.

Two-thirds of companies with at least 500 employees plan to raise workers’ share of premiums.

“The reality is this does eat into money that could be invested in wages,” Nick Stefanizzi, CEO of Northwell Direct, which provides health benefits to self-insured employers, told Fortune earlier this month.

That is the same tradeoff Dillon said some independent practices are considering: dropping health benefits and offering higher wages instead.

Others may reduce benefits or consolidate staff, potentially limiting their ability to treat and serve patients.