Affordable Care Act Insurers Propose Largest Premium Increases Since 2018

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Affordable Care Act (ACA) insurers are proposing their steepest premium increases since 2018, driven by the expiration of enhanced premium subsidies and policies from President Donald Trump's administration. According to a KFF analysis, insurers are asking for a typical rate increase of 15%, with more than a quarter proposing hikes of 20% or more. Rising healthcare costs account for about half of the proposed increases.

The expiration of enhanced ACA premium subsidies at the end of 2025 is prompting insurers to hike rates by an additional 4% on average. These subsidies, created by the Democrats’ American Rescue Plan Act in 2021, enabled lower-income enrollees to sign up for coverage with low or no monthly premiums. With their expiration, premium payments are expected to spike by 75% on average, leading many healthier consumers to drop coverage, leaving a sicker pool of policyholders.

Some insurers are also citing tariffs on pharmaceutical imports, which could add 3% to their premium proposals. The tariffs are part of the Trump administration's policies, which have been criticized for contributing to the rate hikes. The Health System Tracker reports that the median proposed rate increase is 15% for 2026.

The Republican "big, beautiful bill" did not include an extension of the subsidies, and it remains uncertain if Congress will address this issue. If not, the subsidies' lapse could leave 5.1 million people uninsured.

Finalized 2026 rates will be published later this summer, with open enrollment starting on November 1.


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