Next year, Americans who buy health insurance through the Affordable Care Act exchanges are set to pay significantly more for coverage—and experts say policies advanced by President Donald Trump and congressional Republicans are at least partially to blame.
An analysis released Friday by the health policy research organization KFF and the Peterson Center on Healthcare found that across a sample of more than 105 ACA marketplace insurers in 19 states and the District of Columbia, companies are set to increase premiums by a median of 15%.
The analysis noted that insurers have cited a number of factors to justify pushing up premiums, including Trump’s tariffs—which could drive up drug, equipment, and supply costs—and the expectation that the Republican-controlled Congress will not extend ACA tax credits that are set to expire at the end of the year.
“If Congress takes no action to renew these enhanced tax credits, enhanced subsidies will expire at the end of 2025, which will cause premium payments for subsidized enrollees to increase by over 75% starting in January 2026,” the analysis states. “Insurers expect a large share of enrollees to leave the market, and that those enrollees will be healthier on average, thus leaving the risk pool sicker on average.”
While many health insurers submitted their rate-hike proposals prior to Republicans’ passage of their sprawling budget reconciliation bill—which includes major attacks on the ACA and Medicaid—the measure could compel insurers to further raise premiums. Higher premiums would leave many more people unable to afford coverage.
The KFF-Peterson analysis also pointed to a Trump administration rule that imposes new restrictions on ACA enrollment.
“Early indications are that individual market insurers will be increasing premiums in 2026 by more than they have since 2018, the last time policy uncertainty contributed to sharp premium increases,” the organizations said.
Vox‘s Dylan Scott noted that “the Republican bill’s changes to Medicaid don’t take effect until the end of 2026, but they could also push premiums higher if millions of people lose coverage as expected.”
“When people lose Medicaid, they are more likely to end up in the emergency room,” Scott explained. “That requires more costly care than they’d get if they were insured. Those increased costs to hospitals are passed on to insured patients when providers negotiate their payment rates with health insurance plans.
Brad Woodhouse, president of the advocacy group Protect Our Care, said in a statement Friday that “Donald Trump and Republicans handed a massive tax break to billionaires and paid for it by ripping over $1 trillion out of our healthcare system.”
“Now hard-working families are stuck with the bill,” said Woodhouse. “Premiums are soaring, uninsured rates are growing, hospitals are closing, and millions are being forced to choose between affording care or covering rent. But this was no accident. It was the plan: decimate American healthcare to line the pockets of the rich, and leave working families to suffer the consequences.”
“The fallout is now hitting working families hard,” he added, “as premium costs are driven to new heights.”
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