Americans who buy health insurance through the Affordable Care Act marketplace could face another sharp increase in premiums next year, with insurers proposing a median 14% rate hike for 2027, according to a new analysis from the Kaiser Family Foundation.
If approved, it would mark the second consecutive year of double-digit premium increases, adding new financial pressure for millions of households already grappling with rising health care costs.
The proposed increases stem from preliminary rate filings submitted by 77 health insurers operating in 16 states and the District of Columbia. According to KFF, insurers point to several factors driving higher premiums, including rising hospital and physician costs, increasing prescription drug spending, particularly for GLP-1 weight loss medications and other specialty drugs, and the expiration of enhanced Affordable Care Act premium subsidies that had helped millions of Americans lower their monthly insurance bills.
The loss of those enhanced subsidies has had the greatest impact on middle-income consumers. Individuals earning more than 400% of the federal poverty level no longer qualify for premium assistance and must absorb the full cost of higher insurance rates.
Although many lower-income enrollees will continue receiving subsidies that offset part of the increase, taxpayers ultimately bear much of that additional cost because federal subsidy payments rise alongside premiums. Higher prices are also reshaping the insurance marketplace itself. As premiums climb, healthier consumers who are more sensitive to costs are increasingly choosing to drop coverage.
That leaves insurers with a smaller pool of policyholders who generally require more medical care, driving average costs even higher and creating a cycle of continued premium increases. KFF estimates that this worsening risk pool added roughly four percentage points to premium growth this year, with insurers expecting a similar effect in 2027.
Enrollment has already begun to decline as federal data released last month showed Affordable Care Act marketplace enrollment fell to approximately 19.2 million people, down by about 3 million from the previous year.
Even so, enrollment remains above levels seen before the record gains of 2024 and 2025, suggesting the marketplace continues to serve a historically large number of Americans despite recent losses. "When you see a decline in enrollment coupled with such a big spike in premiums, neither of those are exactly comforting signs," Emma Wager, senior policy analyst with KFF's Program on the Affordable Care Act, said in the analysis.
She added that "for now the market is holding strong" because enrollment remains higher than in any year before 2024. The premium increases have also become a political flashpoint. Democrats argue that allowing the enhanced Affordable Care Act subsidies to expire has made health coverage significantly less affordable.
Protect Our Care President Brad Woodhouse recently said that "a mind-boggling number of Americans have found themselves joining the ranks of the uninsured," blaming Republican-backed policy changes for rising health care costs. The Trump administration disputes that characterization.
Federal officials say declining enrollment reflects a crackdown on improper and fraudulent enrollments rather than weakening demand for coverage. A Department of Health and Human Services report issued last month said the administration has "utilized numerous tools, mobilizing a full-scale effort to ensure federal subsidies are going only to those for whom they are intended."
