Obamacare insurers request 14% premium hike for 2027, second straight double-digit increase
Insurers on the Affordable Care Act exchanges are proposing a median premium increase of 14% for 2027, according to a KFF analysis of rate filings in 16 states and Washington, D.C., marking a second consecutive year of double-digit increases that have already pushed millions to drop coverage.
Proposed increases
Insurers offering plans on the Affordable Care Act exchanges are requesting a median premium increase of 14% for 2027, according to a KFF analysis of preliminary rate filings by 77 insurers in 16 states and Washington, D.C. Most proposals fall between 10% and 20%, while 20 insurers are seeking jumps above 20%. If approved, it would mark the second consecutive year of double-digit increases, following an average 2026 rise of more than 20%. The cumulative increase from 2025 to 2027 is on track to exceed 33%.
What is driving costs
The filings point to several factors. Insurers estimate that a sicker risk pool (as healthier people drop coverage) is adding roughly 4 percentage points to premiums for the second year in a row. The median underlying medical cost trend has accelerated to 10% for 2027, up from about 8% in prior years, driven by economic inflation, rising drug prices, and higher provider reimbursement demands amid labor shortages. Demand for costly GLP-1 weight-loss drugs also contributes. Some major insurers, including Centene and UnitedHealth, have flagged elevated medical costs in their exchange businesses; CVS Health's Aetna unit already exited the marketplace for 2026.
Enrollment collapse
After the enhanced pandemic-era subsidies expired, enrollment fell 13% in 2026 from 22.1 million to 19.2 million, according to federal data. Without those subsidies, premiums skyrocketed 58% last year and deductibles surged by roughly $1,000 per person. About 4 million Americans have left the marketplace, with continued attrition expected as costs rise. Higher out-of-pocket costs are pushing healthier individuals to drop coverage, worsening the risk pool. Most enrollees with incomes below 400% of the federal poverty level still qualify for subsidies, but those above that threshold face the full brunt of the increases.
- Premium rates prior to subsidy expiration; 22.1 million enrolled
- Premiums rise more than 20% on average after enhanced subsidies lapse; enrollment falls 13%
- Insurers request median 14% increase; cumulative increase exceeds 33% since 2025
Political blame game
The enrollment drop has become a campaign issue ahead of the midterms. Democrats, through groups like Protect Our Care, accuse Republicans of blocking the subsidy extension and driving up costs.
A mind-boggling number of Americans have found themselves joining the ranks of the uninsured.
The Trump administration counters that a crackdown on fraudulent enrollments is largely responsible for the decline.
Market stress but holding
Despite the pressures, the marketplace still covers 19.2 million people (more than in any year before 2024).
When you see a decline in enrollment coupled with such a big spike in premiums, neither of those are exactly comforting signs.
But she notes the market "is holding strong" for now. Insurers are required to finalize their proposals by July 15, after which regulators will review the rates.
