One Battle After Another Heading into Marketplace Open Enrollment for 2027

Health care costs were the number one economic worry among both uninsured and insured adults according to a recent KFF poll, with nearly two-thirds of respondents (62%) saying they are somewhat or very worried about being able to afford health care. And more than half of respondents with ACA marketplace coverage (55%) rate the amount they pay for coverage and the amount they pay out-of-pocket to see a doctor as "fair" or "poor."

It is not surprising that people feel this way; the Trump administration and congressional republicans have demonstrated a seemingly relentless commitment to making it more expensive and harder for people to get and keep high-quality health coverage.

At a time when rising hospital and prescription drug prices are already driving up the cost of health care, the Trump administration and congressional republicans chose to let marketplace premium tax credit (PTC) enhancements expire at the end of 2025. As a result:

• Enrollment is declining steeply. Nearly three million fewer people had marketplace coverage as of February 2026 compared to average monthly enrollment in 2025.

• Premiums went up, coverage got worse. Enrollees' 2026 premiums are up by 58% compared to 2025. People are more likely to be enrolled in a catastrophic or bronze plan (40% in 2026 compared to 30% in 2025), and the average deductible has risen by more than $1,000.

• Plan options are dwindling. Enrollment declines and rising health care costs are driving insurers to raise premiums for 2027 by more than 15%, on average. Nine insurers have announced they are exiting the marketplace altogether.

Ongoing implementation of the Republican health care cuts enacted in July 2025 (H.R. 1) adds salt to these wounds. In addition to making massive cuts to the Medicaid program, the law bars certain legally present immigrants from receiving PTCs, without which most will be unable to afford coverage. Some of these changes have already been implemented, but the marketplace change affecting the largest number of people takes effect starting January 1, 2027. The Congressional Budget Office estimates that, taken together, these marketplace cuts will cause more than one million people to become uninsured. At the same time, the administration's public charge rule finalized in July is creating an increasingly hostile environment for legally present immigrants seeking health care.

The administration has also taken numerous additional actions to make marketplace coverage more expensive and harder to get and keep, including:

• Finalizing regulations that would have shortened the annual open enrollment period, added new paperwork barriers for people trying to enroll, increased the cost of coverage, and watered down the quality of the coverage available through the marketplace. These attempts have been thwarted by federal courts, but not all cases have a final decision, and appeals are ongoing.

• Unprecedented actions to abruptly end enrollment for an estimated 760,000 marketplace enrollees, with more cancelations possible in the coming weeks.

• Proposing an interpretation of the Medicaid provider tax provisions in H.R.1 that would radically destabilize state-based marketplaces if finalized as proposed.

• Slashing federal funding by 90 percent for navigator programs, which provide free, unbiased, culturally competent assistance with health coverage applications and enrollment, while reinstating 850 agents and brokers that had been suspended from selling marketplace plans by the Biden administration because of potential involvement in fraudulent enrollment activity.

Instead of taking steps to meaningfully address consumers' health care affordability concerns, the Trump administration raided the federal marketplace's operational coffers to frivolously send $500 "refund" checks to approximately one million marketplace enrollees with annual incomes above four times the federal poverty level ($62,600 for an individual). These dollars, collected from insurance companies that sell plans on the marketplace, are intended to fund marketplace operations, advertising, and outreach and enrollment assistance efforts. The average unsubsidized marketplace premium in 2026 is $741/month (just shy of $9,000 for the year), and the average deductible is $3,786; $500 would barely put a scratch in either of these burdens. This unserious action neither offers meaningful financial relief from high health care costs for those who received it nor targets relief to those most impacted by the expiration of PTC enhancements. It also reduces the amount of funding available for meaningful investments in outreach and enrollment assistance. This same amount of money - $500 million - could have restored federal funding for navigator programs for the next five-and-a-half years.

The next open enrollment period starts November 1, and once again people are going to experience sticker shock about what they find thererates are going up again. Gross premiums for 2027 are increasing by double digit percentages for the second year in a row. People who are still eligible for premium tax credits will be largely insulated from these hikes, but many people found their premiums this year to be unaffordable, and they will not see relief in 2027.

Policymakers who are genuinely interested in addressing health care affordability should work to restore the PTC enhancements immediately and examine other ways to reduce out of pocket health care costs for people with private insurance as soon as possible. They should also take bold steps to address the root causes of high and rising health care costs over the longer term in order to break the cycle of ever-increasing premiums in the first place. Families USA laid out our principles on how to begin to do this in our recent response to the Senate Democrats' require for information on private coverage, and we look forward to continuing to partner with advocates across the country to fight for meaningful health care affordability