Insurers say higher premiums are driven by rising healthcare costs, broader inflation, a sicker enrollees pool, and the expiration of pandemic-era subsidies.

They also point to new enrollment and eligibility rules from the Trump administration that shift enrollees and affect risk pools, pushing up requests.

Last year’s median proposed increase was about 18%, reflecting the higher-risk pool not offset by healthier members.

Final 2027 rates are awaiting regulatory approval and could change before they take effect.

Most marketplace enrollees earning under 400% of the federal poverty level continue to qualify for subsidies, cushioning some of the cost impact.

Enrollment strategy may require shoppers to compare and possibly switch plans during the 2027 open enrollment to manage costs.

Political dynamics around the ACA have sharpened, with Republicans emphasizing subsidies and Democrats defending subsidies amid concerns about improper enrollments and fraud.

ACA marketplace enrollment declined in 2026, falling to about 19.2 million as enhanced subsidies expired.

As of February, ACA marketplace enrollment was down roughly 3 million year over year, with critics blaming higher costs and subsidy expiration.

Policy changes cited as affecting 2027 rates include expiration of ARPA/IRA subsidies, NBPP adjustments, the Marketplace Integrity and Affordability Rule, and the Working Families Tax Cut Act (HR1).

Overall enrollment in marketplace plans has declined to about 19 million, about 4 million below the prior year after subsidy expiration.

Policy context shows federal lawmakers proposing healthcare overhauls, but no comprehensive law has passed, maintaining affordability concerns ahead of elections.