ACA Marketplace insurers proposing 14% median premium increase for 2027
ACA Marketplace insurers are proposing a median premium increase of 14% for 2027, indicating a likely second consecutive year of double-digit increases.
Objective Facts
ACA Marketplace insurers are proposing a median premium increase of 14% for 2027, making it a likely second consecutive year of double-digit increases following a steep climb in 2026; if these increases hold, typical premiums would jump by more than one-third between 2025 and 2027. Insurers cite rising costs of health services, labor shortages, and general economic inflation driving up provider wages and costs, with the underlying cost of medical care and prescription drugs rising by 10% for 2027. The expiration of enhanced premium tax credits at the end of 2025 led to a 58% average increase in out-of-pocket premiums in 2026; people with incomes at 400% or more of the federal poverty level lost subsidies entirely and face the full increase. Insurers estimate the sicker risk pool from healthier enrollees leaving the marketplace drove 2026 premiums up roughly four percentage points and expect another four percentage point increase in 2027.
Left-Leaning Perspective
The Washington Post describes the 2027 outlook for the ACA as "severe" and notes that "the new predictions are in, and the outlook for 2027 is severe". NPR reports that while "the main takeaway is that enrollment is down 13% from last year," the Trump administration attributes this to "their attempts to address fraud," but health policy experts blame costs. NPR and policy experts including Cynthia Cox from KFF note that "coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments with the expiration of enhanced tax credits," and that fraud allegations are "a theory advanced by the Paragon Health Institute, a conservative think tank," which "many health policy experts are skeptical" about.
Right-Leaning Perspective
The Daily Caller reports that "Obamacare health insurance premiums are set to increase by double digits again in 2027," with "a median proposed premium increase for next year of 14%," noting this "marks the second consecutive year of double-digit premium increases". It attributes increases to "soaring medical service costs, general economic inflation, labor shortages and enhanced federal tax credits expiring at the end of 2025". The Las Vegas Review-Journal editorial argues "this suggests that almost all of the decrease in ACA exchange plan enrollments came from tamping down on fraud and eligibility issues," noting "2.9 million people now aren't receiving subsidies for which they didn't qualify," and concludes "So much for throwing 15 million people off their health insurance".
Deep Dive
The 14% median premium increase proposal represents the second consecutive year of double-digit increases, which would push typical premiums up more than one-third between 2025 and 2027. This moment is the result of a perfect storm of overlapping factors: underlying healthcare cost growth of 10% (driven by specialty drugs like GLP-1s, labor shortages, and provider wage inflation); the political expiration of enhanced federal subsidies at the end of 2025; and a deteriorating risk pool as healthier, price-sensitive enrollees exit the marketplace. When enhanced credits expired, healthier enrollees left, leaving behind sicker and more expensive remaining enrollees; insurers estimate this risk pool deterioration added roughly four percentage points to 2026 premiums and expect another four percentage point contribution in 2027. Federal regulatory changes, including the Trump administration's Marketplace Integrity and Affordability Rule and the 2027 Notice of Benefit and Payment Parameters, have also been cited by insurers as contributing to upward premium pressure. The Trump administration attributes the 3 million enrollment decline to fraud controls, while health policy experts say the lapse of enhanced subsidies is the bigger driver; the fraud argument is seen as "a better political argument for Republicans in a midterm election year". Policy experts note "there's little evidence to support the notion of a fraud clampdown being the primary factor" in the enrollment loss. Both sides have a case: CMS canceled coverage for 250,000 people enrolled without consent, but the growth in enrollment during Biden's term was "a predictable consequence of Congress's investment of billions of federal dollars in making premiums more affordable," and this year's drop is equally "predictable, given that premium costs doubled, on average, from 2025 to 2026" after Republicans let subsidies expire. Insurers exiting the marketplace (Cigna, CareSource, PacificSource, Baylor Scott and White, Providence, Mending) cited "rising costs, declining enrollment, and policy uncertainty as factors behind their decisions". The 2027 NBPP, finalized in May after insurers had already submitted bids, increased access to cheaper catastrophic plans and required stronger eligibility verification, creating uncertainty and timing complications for insurers setting 2027 rates. What comes next: Rates for 2027 will be finalized in late summer, and the market dynamics will depend heavily on whether enrollment falls to the Congressional Budget Office's projected 12.5 million by 2028—nearly half of last year's enrollment—or stabilizes at a higher level.