Many Affordable Care Act insurers are proposing double-digit premium increases for the second year in a row, driven by rising medical costs and policy changes by Congress and the Trump administration.
In preliminary filings with state regulators, insurers are seeking a median rate increase of 14% for 2027, according to an analysis of filings in 16 states and the District of Columbia by the Peterson-KFF Health System Tracker.
If those rates are ultimately approved, it would be the second-highest increase since 2018.
Cynthia Cox, a senior vice president and the director of the Program on the ACA at KFF, said this would be a “triple whammy“ for consumers, as they have already had to pay higher premiums in 2026 and saw the expiration of more generous tax credits to offset their premiums at the end of last year.
President Joe Biden sought to bolster the program known as Obamacare by enacting more generous tax subsidies, driving down out-of-pocket costs for consumers and increasing enrollment to more than 20 million Americans.
As of February, ACA enrollment had fallen by about 3 million people compared with the same time last year.
Cox and other policy experts say that’s because increased costs for the plans drove out people who feel they can get by without insurance.
The main factor driving proposed premium increases for 2027 is the rising cost and use of medical care.
There’s growing demand for costly specialty medications and for the weight loss drugs known as GLP-1s, the Peterson-KFF report notes.
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About 4 percentage points’ worth of the premium increases insurers proposed are due to lasting effects of the expiration of enhanced subsidies.
Insurers expect that with young and healthy people leaving the program rather than paying higher premiums, their remaining customers will be older, sicker, and therefore costlier on average.
Cox said it’s likely that the people who dropped their coverage were also the healthier people, because sicker people were probably going to try to make it work however they could, to stretch their budget to keep their health insurance.
In their rate filings, some insurers also said they had to raise premiums partly because of policy changes by the Trump administration that are expected to make it harder for some people to enroll.
Together with the expiration of the larger subsidies, the new rules “account for 12.7% of the requested rate change,” the insurer UnitedHealthcare wrote in its rate filing with New York state, according to the Peterson-KFF report.
Another driver of higher premiums cited by several insurers is that claims submitted on behalf of patients have tended to be for more intense — and costly — levels of care than in the past.
They may have to shop around when enrollment opens for 2027 coverage in October.
Depending on their particular plan’s premium, they may need to switch plans to keep premiums fixed, said Matthew Fiedler, a senior fellow at the Brookings Institution, who notes that consumers should review their options carefully to find the best health evaluation for their needs.
