Insurers participating in the Affordable Care Act (ACA) are anticipating their most substantial premium increases since 2018, primarily influenced by the upcoming expiration of enhanced premium subsidies introduced during the Biden administration and ongoing tariffs from the Trump era. According to a recent analysis by KFF, a nonpartisan health policy research organization, insurers are seeking an average rate hike of 15%, with over 25% of these insurers proposing increases of 20% or more across 19 states and the District of Columbia.
Similar to the sharp premium hikes observed in 2018—also triggered by Trump administration policies aimed at undermining the ACA—the current rate changes are influenced by a combination of rising healthcare costs and regulatory shifts. Notably, the expiration of the ACA’s enhanced premium subsidies at the year’s end is expected to contribute an additional average increase of 4% as insurers fear losing healthier individuals from their pools, potentially resulting in an unbalanced market with sicker, more expensive policyholders.
Originally established by the American Rescue Plan Act in 2021, these enhanced subsidies allowed many lower-income individuals to secure coverage with little to no monthly premiums, while middle-income families gained access to financial support for the first time. This assistance has led to a record 24 million enrollments in 2025, significantly mitigating the costs for most consumers. However, without the subsidies, premiums could surge by an average of 75%, significantly impacting affordability for many enrollees.
In states like Maryland, insurers have proposed an average premium increase of 17.1%, which represents the highest rate since 2019. The Maryland Insurance Administration suggests that extending the enhanced subsidies could reduce this increase to about 7.9%. Insurers are also grappling with the ramifications of tariffs on pharmaceutical imports, which may add approximately 3% to their proposed premiums.
The implications of the recent legislative changes and upcoming deadlines—such as the start of open enrollment on November 1—are causing uncertainty within the insurance market. KFF’s Cynthia Cox noted that insurers are carefully monitoring the situation to adjust their rates in light of new legislation affecting the ACA.
While challenges persist, there is hope that continued dialogue and possible extensions of the enhanced subsidies may alleviate some of the financial burdens consumers face in the upcoming enrollment period.
Overall, the evolving healthcare landscape necessitates vigilance from both consumers and policymakers as they navigate these complex dynamics in health insurance pricing and accessibility.