The paper that matters here is not a press release. It is an actuarial filing - the document an insurer must submit to regulators explaining, line by line, why next year's premium is what it is. Seventy-seven of them, across 16 states and Washington DC, are now in for 2027, and KFF's analysis of the stack finds a median proposed increase of 14 percent, with most filings between 10 and 20 percent and twenty insurers above 20 [1]. That lands on top of 2026's finalized median of 20 percent [1][3]. Two years, more than a third added to the sticker.
Data
| 2026 (finalized) | 20% median increase |
|---|---|
| 2027 (proposed) | 14% median increase |
Washington answered the filings with two stories. From the White House's Kush Desai: 'It is not surprising insurance conglomerates that profited massively off of Biden-era fraud are complaining about efforts to clean up the program' [2]. From the DNC's Kendall Witmer: 'Healthcare is unaffordable for millions of Americans because Donald Trump and Republicans sold them out to give billionaires even bigger tax cuts' [3]. A villain each, delivered within hours.
The filings themselves are more specific than either. The largest driver, as in most years, is medical costs: hospital prices, physician prices, and the surge of GLP-1 and specialty drug spending [1]. The policy-made share is quantified too: the expiration of the enhanced premium tax credits - which Congress let lapse at the end of 2025 - contributed roughly 4 percentage points to 2026 increases, and insurers expect roughly 4 more in 2027, because the people who leave when subsidies shrink are disproportionately the healthy ones, and a sicker pool costs more to cover [1]. The lapse's real-world record is already measured: average out-of-pocket premium payments rose 58 percent this year, enrollment fell by about 3 million people by February, and a single person earning just over 62,600 dollars lost subsidy eligibility entirely [2].
Score the two stories against the document. The White House frame - insurers complaining about 'fraud cleanup' - explains none of the arithmetic: removing enrollees, fraudulent or otherwise, shrinks and sickens the risk pool, which is a reason premiums rise, and the filings say so; a cleanup that made coverage cheaper would be the first in actuarial history. The DNC frame points at a real, chosen, quantified cause - the lapse Congress declined to prevent owns its 4-points-a-year and its 3 million departures - but stretches it over the whole 14 percent, when the filings put medical costs first. One story is wrong about the direction of its own policy; the other claims too much credit for the villain it prefers.
What a shopper actually needs is the sentence neither party said: premiums are rising mostly because care costs more, plus a measurable surcharge each year from the subsidy lapse, and the surcharge - unlike the price of a hospital day - is a thing Congress could reverse before the July 15 filings close and the rates finalize this fall [1][2]. The filings are public. The record is in them, not in the statements about them.
