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The annual rate-filing season has arrived, and the early numbers are sobering. According to a new Peterson-KFF Health System Tracker analysis of filings in 16 states and the District of Columbia, ACA Marketplace insurers are proposing a median premium increase of 14% for 2027. This marks the second consecutive year of double-digit hikes and, if these rates are finalized, typical Marketplace premiums will have climbed by more than a third in just two years.
As we wrote about last month, the provisional insurance premium increases in Oregon are even higher, around 17% for the individual market.
In their 2027 filings, insurers attribute much of the increase to provider costs, citing contract increases, rising claims severity, and factors like consolidation.
The reality is far more nuanced, and we believe KFF’s data paints a picture of coverage policy failures and real and rising costs of caring for patients. Increasingly, that burden is shifting onto the hospitals that anchor our communities.
ACA coverage losses
The driver that most distinguishes this year’s filings isn’t anything hospitals did — it’s what Congress didn’t do — extend the enhanced premium tax credits that expired at the end of 2025.
The results were immediate and predictable. Marketplace enrollment fell by roughly 3 million in 2026 as net premium payments spiked. Healthier enrollees, the people who make an insurance pool actuarially sound, were the first to walk away. Insurers across the country are now building “morbidity adjustments” into their 2027 rates, some in the range of 4.7% to 6%, because the people left in the risk pool are, on average, sicker and costlier to cover. And they expect the erosion to continue into 2027.
It’s widely accepted that people who drop coverage, do not stop getting sick, but they do often cut preventive care, delay treatment until conditions become acute and eventually arrive in our emergency departments. We care for all patients who arrive in our emergency department, regardless of their insurance coverage or ability to pay – doing so is fundamental to our mission.
At the same time, these coverage losses have direct financial impacts that result in increasing levels of uncompensated care. This will only be exacerbated further next year when Medicaid cuts start to impact patients.
The policy prescription for these coverage losses is straightforward – restore the enhanced premium tax credits. The KFF analysis shows insurers themselves attribute multiple percentage points of annual premium growth to the expiration. Reversing it would likely lower premiums, stabilize the risk pool, and keep patients insured and connected to care.
Why provider costs are rising
The filings cite growth in provider prices as a core component of the 10% median medical trend. What the headlines miss – why those prices are rising.
The insurers’ own words tell the story. One health plan acknowledged that local hospital systems have been squeezed by both inflation and staffing shortages, and that contract increases were a response to those documented pressures. Another insurer similarly tied provider reimbursement requests to the elevated inflationary environment and labor shortages.
Hospitals have lived this reality since the pandemic. Labor, our single largest expense, has been repriced across the entire economy. Increased competition for a limited pool of clinicians has driven wages higher across key healthcare roles.
Supplies, drugs, and equipment have all inflated. Unlike almost any other industry, hospitals do not pass these costs directly to consumers; we can only recover them through periodic contract negotiations with payers, often years after the costs were incurred.
What insurers describe as provider price growth is, in large part, hospitals attempting to catch up to costs we have been absorbing.
Higher deductibles hurt patients and hospitals
There is one more thread in the KFF analysis that deserves attention. As subsidies shrink and premiums rise, enrollees are migrating to bronze plans with lower premiums and much higher deductibles.
Hospitals and patients are on the same side of this problem. High-deductible coverage means patients delay care they can’t afford out of pocket, then face bills they cannot pay when care becomes unavoidable. Hospitals, in turn, absorb the growing gap between what care costs and what underinsured patients can contribute. A plan that leaves a family exposed to a $10,000 deductible offers limited real protection.
Key takeaways
The 2027 rate filings are yet another warning light signaling instability in the American health care system. Hospitals didn’t cause the coverage cliff, the labor crisis or the inflation wave, but time and time again are the ones asked to absorb the consequences.
Policymakers who want lower premiums should start not by squeezing the institutions that care for their communities, but by keeping their constituents insured in the first place.
