Millions of Americans will face sharply higher health insurance costs starting next month, whether they buy coverage through the Affordable Care Act exchanges or receive it through their jobs. The increases, which experts say are the steepest in years, are quickly becoming a defining issue in the 2026 midterm elections.
Premiums for some ACA plans are projected to rise by a median of 15% for 2027, according to a KFF analysis of insurer filings in all 50 states and Washington, D.C. That follows last year's 20% median increase, making it the second consecutive year of double-digit hikes and the highest requested rate change since 2018. For employer-sponsored plans, costs are expected to jump 8% to 10%, the largest rise in over two decades, according to the benefits consulting firm Marsh.
The drivers are familiar: hospitals and other providers are charging more, patients are using more expensive care, and the growing use of costly GLP-1 weight-loss drugs is pushing up spending. But the political fallout is magnified by the expiration of enhanced ACA subsidies, which Republicans allowed to lapse last year. Those subsidies had lowered premiums for many middle-income enrollees during the pandemic.
“We’re seeing a sicker risk pool because younger, healthier people are dropping coverage without the subsidies,” said Justin Lo, a senior researcher at KFF’s ACA program. He noted that insurers cited expected enrollment declines and higher-risk enrollees as key reasons for the premium increases.
The cost crunch has resonated with voters. A KFF poll found healthcare costs and gas prices top the list of economic concerns ahead of the midterms, outranking food, housing, and utilities. A Pew Research Center survey earlier this month showed 64% of Americans call healthcare a “very important” issue, placing it above immigration, foreign policy, crime, and AI.
Democrats are seizing on the issue, campaigning on plans to restore the enhanced subsidies. “Voters clearly blame Republicans for the premium spike,” said Katherine Hempstead, a senior policy officer at the Robert Wood Johnson Foundation. But she cautioned that subsidies alone won’t solve the underlying problem: “It’ll cost less to the people buying it, but it’s not doing anything to address how much healthcare services and prescription drugs cost.”
For the 160 million Americans with employer-based coverage, the pain is also mounting. Family premiums averaged about $27,000 last year, and employees often face deductibles exceeding $3,000 on top of that. “Stack it all up, and many families are paying close to $10,000 a year out of pocket,” said Erica Socker, a research professor at Georgetown’s Center on Health Insurance Reforms.
Small businesses are particularly vulnerable. As employers grapple with higher costs, many are shifting expenses to workers through higher deductibles, stricter prior authorization, or cutting coverage for expensive drugs like GLP-1s. “A lot of times that’s just taking away options employees really want,” Hempstead said.
With the midterms approaching, the issue is likely to intensify. Recent polling shows corruption and economic concerns dominate voter worries, but healthcare affordability is close behind. Democrats are betting that restoring subsidies will resonate, while Republicans argue that market-based reforms are needed to control costs. Meanwhile, independent forecasters have shifted some House races toward Democrats, and record ad spending is pouring into the battle over healthcare.
For now, Americans are bracing for the financial hit. “It’s the sleeper issue of this election,” said Lo. “But it’s about to wake up.”
