Overview
- Federal state-by-state data posted in late June show roughly 2.6 million fewer people held Affordable Care Act plans year over year, with Ohio and Oklahoma each losing more than 32% of their enrollees.
- A KFF analysis of preliminary insurer filings published July 8 found a median requested premium increase of about 14% for 2027 across 77 plans in 16 states and Washington, D.C., with many companies seeking hikes between 10% and 20%.
- Policy changes are a central part of the debate: analysts point to the Jan. 1 expiration of pandemic-era enhanced premium tax credits as the main cause of the enrollment drop while HHS has attributed some losses to enforcement removing improper or fraudulent enrollments.
- Insurers list rising hospital and drug costs—including expensive specialty drugs such as GLP-1s—greater claims severity, workforce pressures and a smaller, sicker risk pool left behind after healthier enrollees departed as drivers of the requested rate increases.
- States can shape outcomes this summer because regulators will finalize rates later in the season and a few states, notably New Mexico, have used state funds to replace lost subsidies and reversed enrollment declines, a model other states may consider.