Obamacare is facing a perfect storm. ACA insurers are seeking a median 14% premium increase for 2027 — the second-highest since 2018 — as enrollment has already plummeted by nearly 3 million people following the expiration of enhanced subsidies. Rising medical costs, a sicker enrollee pool, and policy changes are all fueling the squeeze.
The Affordable Care Act is under serious strain. Insurers are requesting a median 14% premium increase for 2027 — what experts are calling a "triple whammy" for consumers who already absorbed higher premiums in 2026 and lost enhanced tax credits at the end of last year. The proposed hike would be the second-highest since 2018, driven by rising medical costs, growing demand for specialty drugs and GLP-1 weight-loss medications, and a shrinking, sicker enrollee pool.
Enrollment has dropped sharply. About 19.2 million people were enrolled in ACA marketplace plans as of February — down nearly 3 million from 2025, a 13% decline. States like Ohio and Oklahoma each lost over 32% of their enrollees. Health policy experts point to the January 2026 expiration of enhanced premium subsidies, which caused average premiums to jump 58% and deductibles to hit a record high of $3,786. Fewer insurers are also participating — the average dropped from 9.6 to 9.0 per state — with major exits from Aetna and Cigna already underway.
By the Numbers:
Why it matters: The ACA's coverage landscape is contracting rapidly, with healthier enrollees exiting and sicker ones staying — a dynamic that pushes premiums even higher. Without policy intervention, millions more Americans could find themselves uninsured heading into 2027.
