ACA open enrollment begins amid rising costs and policy shifts

Several factors are contributing to these shifts. Financial assistance, such as premium tax credits and cost-sharing reductions, is now unavailable to a broader range of individuals compared to previous years. Experts at KFF project an average 13% increase in health insurance costs for marketplace purchases in 2027. This rise is attributed to escalating healthcare expenses, consolidation within hospital systems, and the impact of legislation like the No Surprises Act, alongside the increased use of GLP-1 medications.

“They may or may not be able to afford to continue to keep their coverage into next year,” stated Cynthia Cox, Vice President and Director of the ACA program at KFF, noting that many are already opting for the most affordable bronze plans.

While the Centers for Medicare & Medicaid Services (CMS) asserts that HealthCare.gov will provide access to affordable plans, the reality for many is more complex. The rising costs are largely a consequence of the expiration of COVID-era subsidies previously supported during the Biden administration. This expiration led to a decrease of 1.2 million enrollments.

As of February, approximately 19.2 million people were enrolled in ACA marketplace health plans, a figure boosted by enhanced subsidies introduced through the American Rescue Plan Act and the Inflation Reduction Act.

New regulations will also restrict tax credits for some lawfully present immigrants, potentially increasing the number of uninsured individuals by an estimated 1 million. Concurrently, the Trump administration is undertaking efforts to remove individuals from ACA programs, citing concerns about fraud and waste. In September, Vice President JD Vance announced the removal of 760,000 enrollees, projecting $2.2 billion in savings.

The full extent of the impact on ACA enrollment in 2027 remains uncertain, but experts anticipate a decline, complicated by evolving eligibility rules and ongoing fraud prevention measures.