Three things that explain what's changing with Obamacare in 2027

By Jaimy Lee

Affordable Care Act premiums are increasing again, and these plans have new rules

ACA premiums are increasing 13% in 2027, raising questions about the affordability of the health plans.

Affordable Care Act premiums are going up again, and that may force more Americans to go without health insurance.

The median increase in the cost of mid-tier health-insurance premiums sold on Healthcare.gov or through state marketplaces is 13% in 2027, according to KFF. That's lower than the 26% median increase for 2026, but still far higher than the single-digit percentage increases in the years immediately before that.

Much of the focus last year had to do with the expiration of enhanced premium tax credits, which were given to middle-class Americans to lower the cost of their premiums. There are different issues to deal with this year. Along with new rules about who can enroll in ACA plans in 2027, Americans are also grappling with the rising cost of living.

"There's always trade-offs," said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, "but I think that we're starting to see healthcare eat up other things - eat up people's ability to save for the future or pay other bills."

It's also eating up Americans' ability to pay for their own health insurance. By June of this year, about 3 million Americans had opted out of their ACA plans. And as costs continue to climb, even more people in the U.S. are expected to drop their ACA coverage in 2027.

"Some people made an enormous sacrifice to stay in there in 2026 and are not able to do the same thing in 2027, even if they're not being asked to spend that much more," Hempstead said.

Along with those who have dropped coverage, some people have picked plans with lower premiums, hoping to balance the monthly cost with their desire to continue coverage. About 19% of Americans with ACA plans said they downgraded their coverage to a plan with lower premiums and higher out-of-pocket costs in 2026, according to a Commonwealth Fund survey conducted earlier this year.

"People are essentially buying down their coverage because they're faced with these big premium increases," said Sara Collins, a senior scholar at the Commonwealth Fund.

But having a plan with a higher deductible puts patients at risk of big medical bills. The same survey found that 30% of adults between the ages of 19 and 64 are paying off medical debt. Most of the participants said they are underinsured, meaning they have a plan with high cost-sharing or have experienced a gap in coverage.

The open enrollment period for ACA plans is under way - it began Nov. 1 and ends Dec. 15, with coverage to start on Jan. 1. Here are three things for Americans to understand about the ACA in 2027.

1. ACA plans are more expensive and have more rules

The median cost of a monthly premium in 2027 works out to $704 per person, according to KFF. That's up from $624 in 2026 and $497 in 2025.

Over the past two years, the premiums for these plans have soared 42%. For many people in the U.S., this puts coverage out of reach.

Some Americans can still get help from premium tax credits. If a single person makes less than $63,840 or a family of four brings in less than $132,000, they qualify for tax credits. The enhanced tax credits at the center of last year's shutdown of the federal government went to people who made more than that.

"The people who lost eligibility for any premium tax credits - these middle-income people - they are the ones that are going to have to shoulder this 13% increase," said Matt McGough, a policy analyst for KFF's Program on the ACA.

But higher premiums aren't the only notable issue this year.

There are also stricter rules about who can enroll in an ACA plan, stemming from President Donald Trump's One Big Beautiful Bill Act. Starting Jan. 1, certain legal immigrants can't participate in ACA coverage, while people who were covered by Medicaid but no longer qualify due to the new work rules won't qualify for tax credits.

Another change is the elimination of "repayment caps" for the tax credits. In the past, people who received the tax credits but underestimated their income didn't have to pay back the full amount. That's changing for the 2026 tax year. Some people will now have to pay back the entire difference.

2. Democrats and states are exploring ways to fix the enhanced tax credits

Democratic lawmakers have talked about trying to bring back the enhanced tax credits as leverage in upcoming debt-ceiling talks. However, that wouldn't happen until next summer, and Trump will still have to sign off on any changes.

"We are skeptical of a deal on the ACA subsidies," Kim Monk, an analyst at Capital Alpha, wrote in a note last week.

That said, some states have stepped in with their own programs that help cover ACA premiums for people in their communities. New Mexico last year backfilled all of the enhanced tax credit dollars for its residents, and enrollment in the state's ACA plans rose. California did the same. Rhode Island and Virginia have now created programs for 2027 that offer some residents financial assistance with their premiums.

But policy experts interviewed for this story believe that growing frustration with the U.S. healthcare system means that more Americans, regardless of political party, are open to making bigger changes to the system as a whole.

"People are saying, 'OK. We need to do more than bring those enhanced premium tax credits back. That's going to help 9% of the population,'" Hempstead said. "But the rest of the population is having a big problem affording their healthcare."

3. It's not just the ACA. Healthcare costs are soaring across the U.S.

Much of the increase in the cost of ACA premiums in the last two years has to do with the loss of the enhanced tax credits. But the rising cost of healthcare across the board is also playing a role.

The monthly premium for Medicare's prescription drug plans is jumping 50% in 2027, while the cost for an employer to cover an employee is rising by 8.2%. More companies are putting restrictions into place about how they cover care, whether that's cutting GLP-1 benefits for weight loss or no longer covering family members. Disney (DIS) and the grocery chain Albertsons (ACI), for example, have both said they only plan to cover their workers going forward, not working spouses or domestic partners.

The cost of medical care and prescription drugs is increasing, and healthcare spending has largely outpaced inflation over the last 15 years, according to new research from the Health Care Affordability Lab at Yale University. The ACA market isn't even lucrative for health insurers. Cigna (CI) is exiting all 11 states where it offered ACA plans, and Molina Healthcare (MOH) is reducing its presence in states where it provides ACA plans.

"It signals that there's going to be less choice for a lot of consumers on the ACA marketplaces," KFF's McGough said.

-Jaimy Lee

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11-05-26 0904ET