ACA marketplace premiums are set to rise a median of 14% in 2027 — the second straight year of double-digit hikes. Expiring subsidies, rising drug costs, and a shrinking, sicker enrollee pool are all fueling the surge. Enrollment has already dropped by 3 million people year over year, raising fresh concerns about the health affordability crisis.
Obamacare marketplace premiums are on track to jump a median of 14% in 2027, marking the second consecutive year of double-digit increases, according to a KFF analysis of 77 health plans across 16 states and D.C. Insurers point to two main culprits: the expiration of enhanced ACA subsidies and rapidly rising healthcare costs — including a 10% spike in medical care and prescription drug costs for 2027, outpacing the 8% average growth seen in recent years.
The situation is creating a troubling feedback loop. Higher premiums are pushing healthier, price-sensitive enrollees out of the market, leaving a sicker — and more expensive — risk pool behind. Insurers estimate this dynamic added roughly four percentage points to premiums this year alone, with a similar hit expected in 2027. ACA enrollment has already fallen by 3 million people year over year, down to 19.2 million.
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Why it matters: For patients and providers alike, rising premiums and shrinking enrollment signal a worsening affordability crisis. Fewer insured Americans means delayed care, greater financial strain, and higher uncompensated care burdens — challenges that ripple across the entire healthcare system.
