ACA insurers propose biggest premium hikes since 2018 as Trump policies take hold

CNN

7 days ago

Affordable Care Act insurers are proposing their steepest premium increases since 2018, driven in part by the looming expiration of Biden-era enhanced premium subsidies and by the Trump administration's tariffs, a new KFF analysis has found.
Insurers are asking for a typical rate increase of 15% with more than a quarter proposing hikes of 20% or more. KFF, a nonpartisan health policy research group, looked at 105 Obamacare insurers in 19 states and the District of Columbia that have filed rates so far.
Steep rate increases in 2018 were also fueled by Trump administration policies, which were focused on weakening the ACA during the president's first term after Republicans in Congress failed to repeal it in 2017.
While rising health care costs account for about half of the coming year's proposed increases, two other forces under the control of President Donald Trump and congressional Republicans are also driving up rates, KFF found.
The expiration of the enhanced ACA premium subsidies at the end of this year is prompting many insurers to hike rates by an additional 4%, on average. Insurers are concerned that the disappearance of this beefed-up assistance will prompt many, largely healthier consumers to drop their coverage — leaving sicker, costlier policyholders on the exchanges.
Initially created by the Democrats' American Rescue Plan Act in 2021, the enhanced premium subsidies enable lower-income enrollees to sign up for coverage with very low or no monthly premiums. Also, middle-income Americans can qualify for assistance for the first time. The Biden administration repeatedly said the more generous subsidies allow the majority of enrollees to select plans that cost less than $10 a month.
The enhanced subsidies helped drive Obamacare signups to a record 24 million people for 2025. Most enrollees qualify for subsidies, which greatly lower their monthly premium payments. But once the beefed-up assistance lapses, those payments are expected to spike by 75%, on average, KFF said.
Trump and GOP lawmakers did not include an extension of the subsidies in their 'big, beautiful bill' and it remains to be seen whether they push for it in subsequent legislation. However, the clock is ticking since insurers are currently finalizing their rates, and the Obamacare federal and state exchanges need time to prepare for open enrollment, which starts on November 1.
Several states are highlighting the looming loss of the enhanced subsidies as driving up insurers' proposed rates on their exchanges.
In Maryland, for instance, carriers have requested an overall average premium change of 17.1%, the highest since 2019. If Congress extends the enhanced subsidies, the rate increases would be 7.9%, on average, according to the Maryland Insurance Administration, which is looking into creating a state-sponsored subsidy to offset some of the premium increases.
Also, some insurers are pointing to the tariffs that the Trump administration has promised to impose on pharmaceutical imports, KFF said. Those that cite tariffs say the levies will add 3% to their premium proposals.
The rate filings, however, do not mention specific impacts of the 'big, beautiful bill' because insurers generally had to submit their proposals prior to the bill being signed into law on July 4. Those that mention it point to the uncertainty it is causing, said Cynthia Cox, director of KFF's Program on the ACA.
'We're going to be watching over the next few weeks whether insurers come back and say, 'the big, beautiful bill passed, and here's how we think that might affect our premiums,'' she said.
The filings also don't take into account the provisions in a rule that the Centers for Medicare and Medicaid Services finalized in late June that will make several changes to Obamacare, including shortening the open enrollment period, increasing verification requirements and limiting the ability of low-income Americans to sign up for coverage year-round. The measures are a 'mixed bag' for insurers in terms of how it might affect premiums, Cox said.
One major insurer has already announced its departure from the Affordable Care Act in 2026. Aetna said in May that it would stop selling plans on the individual market because 'it became clear we would not be able to provide the same level of value we've offered in prior years,' the company said on its website. The insurer also left the Obamacare exchanges in 2018 but later returned.
Insurers' 2026 rates are preliminary and are subject to change, particularly in states that run their own exchanges, where state regulators have more of a say in setting the final rates. The final rates should be published later this summer, and consumers will be able to view plan premiums shortly before open enrollment starts.