Consumers are raising concerns about the increasing prices of food and gasoline. However, these hikes are minor compared to the steep rise in Affordable Care Act (ACA) premiums. The trend raises a valid question: Should it be called the Unaffordable Care Act?
A recent report by the Peterson-Kaiser Family Foundation looked at 276 health insurers across all 50 states. It revealed a median ACA premium increase of 15 percent for 2027. Alarmingly, 90 insurers expect premiums to rise between 20 and 35 percent or more. This follows a 20 percent increase in 2026, suggesting premiums could surge by 40 to 50 percent over two years for many ACA policyholders.
Democrats and mainstream media attribute these increases to President Trump and Republicans. However, critics argue that Democrats should bear most of the responsibility. Warnings about price hikes and fewer insured individuals were ignored when the ACA was enacted.
As the ACA’s Open Enrollment period begins, the Kaiser Family Foundation highlights a significant dropout rate. Enrollment in the individual insurance market fell 18 percent from June 2025 to June 2026. The market serves those without employer-based or government healthcare, requiring them to purchase health insurance on their own.
According to Kaiser, around 4.6 million people, out of 20.5 million, could exit the ACA market. The expiration of enhanced premium tax credits and policy shifts contribute to this decline. As premiums increase, more people, especially younger and healthier ones, may opt out, finding insurance too costly even with subsidies.
This trend presents an economic and actuarial challenge. Insurance pools thrive on a large number of healthy individuals paying premiums to cover the costs incurred by those needing substantial care. With fewer young and healthy individuals, the pool becomes smaller and sicker. This leads to rising premiums, triggering more dropouts, an effect known as the “death spiral” in insurance terms.
Another issue exacerbating this spiral involves fraud, waste, and abuse in the system. The Department of Health and Human Services reported that during and after the 2026 Open Enrollment Period, there were 2.6 million improper and phantom enrollments, with over 1 million lacking a Social Security number. Removing these invalid enrollments cuts taxpayer subsidies, worsening financial strain.
The narrative that Republicans and President Trump are at fault due to non-renewal of enhanced subsidies is misleading. ACA premiums have consistently risen due to the law’s structure and mandates. Initially, generous subsidies were included in the ACA of March 2010. In 2021, under the Biden administration, temporary enhanced subsidies were introduced as part of pandemic relief efforts.
The refusal to renew these enhanced subsidies by Republicans didn’t cause the premium hikes; these subsidies masked real costs. Without changes, the ACA may shrink significantly, serving primarily sick individuals with high premiums.
Can anything change the ACA’s trajectory? Enhanced subsidies are one potential solution. Should Democrats regain congressional and presidential control in the 2028 elections, they might push for further enhanced subsidies, easing the dropout rate. However, this approach doesn’t make insurance affordable but shifts costs to taxpayers.
Presented by Merrill Matthews, Texas state chair of Our Republican Legacy. Copyright 2026 Nexstar Media Inc. All rights reserved. This material is for informational purposes only.