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Affordable Care Act (ACA) patients saw large out-of-pocket premium increases coming into 2026. Insurers were concerned that given the expiration of the temporary premium subsidies, healthier patients would forgo coverage, meaning a remaining patient population that is likely to require more medical care, and therefore, more expense. KFF Health News reported that "insurers are seeking a median rate increase of 14% for 2027." Apparently, there is some concern that new policy changes and regulation will "make it harder for some people to enroll." UnitedHealthcare wrote that the changes "account for 12.7% of the requested rate change." However, the article notes that "There's growing demand for costly specialty medications and for the weight loss drugs known as GLP-1s."

Although general inflation is high, growth in health insurance premiums continues to be much higher. Increasing subsidies helps patients in the short-term, but addressing the underlying cost of care seems to be the correct long-term policy. Unfortunately, slowing the growth of medical care might involve the curbing of benefits and less profit for providers and payers.

Healthcare affordability seems to be a growing concern, especially after a temporary healthcare exchange subsidy expired and the federal government's adding work requirements for Medicaid eligibility. KFF Health News published a brief on the state of Indiana attempting to rein in healthcare costs by establishing a price cap for hospital procedures. The brief notes that "Indiana isn't the only state targeting hospital prices, but it's a rare Republican-controlled state doing so." The governor indicated that "the healthcare system is too broken to leave alone."

KFF Health News also published an article about how healthcare affordability might play a big role in gubernatorial race in Nevada. Understandably, people can be very afraid when they lose access to health care, and it would not be surprising if it turns out to be a major enough issue for politicians of both parties to be concerned.

The practice of requiring providers to secure approval before performing a procedure is known as prior authorization. It is a tool for insurance companies to help control costs, but as one KFF Health News article points out, "Consumers and clinicians largely detest prior authorization." Perhaps unsurprisingly, in the current federal administration's effort to reduce costs, the practice of prior authorization is being tested out in traditional Medicare, which previously did not employ that practice. One point of irony is that this is happening as the federal government is currently trying to get commercial insurers to curb the practice.

This pilot seems to have been complicated by a rushed implementation and the seeming use of unreliable artificial intelligence. The article also points out that denials have been appealed, raising government costs. It is unfortunate that patients and providers bear the cost of a shaky rollout in terms of time and effort.

KFF Health News published a more qualitative feel for what the expiration in premium subsidies means for families across the nation. The main family that was profiled saw that their monthly premiums "would jump from $130 to more than $550" and decided to cancel their health insurance. Their decision is especially notable given the previous injuries from their work. In the family's state of North Carolina, "individual ACA sign-ups for 2026 were down 22% compared with the year before." A nonprofit organization in the same state saw nearly 100 clients (out of about 700 that they worked with during open enrollment) decide similarly to drop insurance. The article points out that such large drops in coverage could be the start of a "death spiral," where "healthier people drop out of the risk pool, fewer people subsidize the people who get sick... That means premiums for the people who get sick will increase again in the future."

While not the only factor, one underlying cause of the rise in insurance premiums is the rise of health care itself. Without addressing that factor, debating whether subsidies should continue only considers who should shoulder the cost of care, and to what extent (whether that be taxpayers or individuals).

Some temporary tax credits for the Affordable Care Act expired last year, and KFF Health News released a plethora of statistics to paint a picture of how the expiration of those subsidies affected enrollment. Perhaps most compelling is that "People with incomes above 400% up to 500% FPL [federal poverty level], who represented just 3% of 2025 sign-ups, accounted for 27% of the drop in sign-ups from 2025 to 2026." 400% of the federal poverty level is "where eligibility for premium tax credits ends" (also known as a subsidy cliff). Another statistic is that even though "Plan sign-ups fell by over a million to 23.1 million people during the 2026 Open Enrollment Period," that drop does not count people who were automatically enrolled, but ultimately do not pay their premiums. One estimate is that the number of people who enrolled and will actually pay their premiums "could decline by between 17% and 26% in 2026 compared to the [2025] number." These statistics may be the result of another statistic that "Premium payments from enrollees increased by an average of 58%." Another statistic is that "From 2025 to 2026, the average deductible in the ACA Marketplaces has grown by over a thousand dollars per person, a 37% increase, from $2,759 to $3,786," which "marks the steepest increase ever in the average Marketplace deductible since the markets launched in 2014."

These numbers demonstrate that health insurance remains expensive for many Americans. If persistent, the rise in uninsured will likely affect more than just those who cannot afford health insurance. For example, emergency rooms might close if they become highly unprofitable if those who are are without health insurance visit in much greater numbers and do not pay.