Rena Bumbray-Graves’ doctors told her late last year to start using a CPAP machine at night. She was struggling to breathe from lung scarring caused by three pulmonary embolisms.
The 63-year-old from Woodbridge, Virginia, hasn’t followed their advice — because she can’t afford to rent one of the devices. She’s been uninsured since January, after finding out the premium for her and her husband’s health insurance marketplace plan would rise from $544 to more than $1,400 a month.
Now, insurers are eyeing similarly hefty rate hikes for 2027.
Dozens of insurers in 16 states and D.C. have proposed increasing next year’s premiums by a median of 14%, according to a review of initial rate filings by KFF, a nonpartisan health policy organization.
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Insurers have until July 15 to submit next year’s premiums to state regulators to justify price changes. Most of the 77 insurers tracked by KFF requested increases between 10% and 20%, but 20 requested even higher increases.
Last year, marketplace insurers across the country hiked premiums by a median of 20%. As a result, millions of Americans are facing similar circumstances to Bumbray-Graves’, some fleeing the Affordable Care Act marketplaces under skyrocketing premiums and others sticking around only to foot much higher monthly payments.
Roughly 19 million people still get health insurance from the marketplaces created by former President Barack Obama’s signature health care law, down from roughly 22 million last year. But enrollment could further atrophy if insurers follow through on what could be the second-highest premium hikes in nearly a decade.
The KFF researchers wrote that if the insurers follow through, “typical premiums for insurers participating in the ACA Marketplaces will have jumped by more than one-third over a two-year period.”
Some insurers are eyeing the exits. Cigna is leaving all 11 state marketplaces it had participated in. The nonprofit Baylor Scott & White Health Plan is discontinuing coverage in Texas. Some plans in Indiana, Montana and Oregon have announced they’re leaving the states’ marketplaces.
A spokesperson for the Centers for Medicare and Medicaid Services said the administration doesn’t anticipate any counties will be left without an insurance carrier – a concern the first Trump administration faced, but managed to avoid, in 2017 and 2018.
The cost hikes and insurer exits are reminiscent of the early days of the Affordable Care Act marketplaces.
The expiration of extra subsidies provided during the COVID-19 pandemic — which the Republican-led Congress refused to extend last year — is one driver of returning premium spikes, according to the KFF report.
Other factors include rising costs for hospitalizations, physician visits and prescription drugs, including expensive GLP-1 drugs, and health worker shortages driving up labor costs, the researchers wrote.
“We have grave concerns about the future of the individual market, although no one should be surprised by the turn of events,” said Ceci Connolly, president of the Alliance of Community Health Plans.
The politics around the Affordable Care Act have flipped under the second Trump administration.
For more than a decade, Democrats defended the marketplaces while Republicans cast them as unaffordable. That has reversed, with the Trump administration stressing that the majority of consumers can still get subsidies to help lower their monthly payments and blaming a much larger share of the enrollment declines on fraud than it has provided evidence for.
The CMS spokesperson said the agency estimates as many as 2.6 million improper enrollments remain in the marketplaces. Fraud by agents and brokers was a problem during the Biden administration but it’s unclear how big the problem remains.
“The Trump administration remains committed to safeguarding the program’s long-term stability,” the spokesperson said.
Democrats are still calling for an extension of the extra subsidies and accusing the administration of undermining the marketplaces.
“There’s no flaw in the ACA,” said Leslie Dach, founder of the Democratic-aligned advocacy group Protect Our Care who was a senior counselor at the Department of Health and Human Services during the Obama administration.
“The flaw is with the Republicans who, despite all the politics and despite all the clear evidence that America is better off, wanna gut the thing,” he said.
Other Democrats involved in the crafting of the health care law also view it as a success, despite the bumps. For the first time, the marketplaces offered Americans without employer-sponsored or government insurance coverage a way to buy plans and get income-based subsidies to help afford them.
“We had as many as 24 million people getting insurance coverage because of the ACA,” said Massachusetts Institute of Technology professor Jonathan Gruber, referring to peak enrollment numbers right after the pandemic. “That’s a pretty damn big success.”
Bumbray-Graves’ husband, Cliff Graves, who has Type 2 diabetes, was able to get insured through his employer, but she said joining his plan would have been even more expensive than staying on their marketplace plan.
So this year she has been paying out of pocket for nine medications to treat her chronic pain, blood clotting disorder and other conditions. She has been working with nonprofits to see if she can get help buying a CPAP machine.
She said she doesn’t have employer-sponsored coverage because she stays home to care for two wheelchair-bound relatives, an adopted sister and a great niece.
“Not allowing the people who are helping people to get insurance — a lot are going to be left without people who can help them,” she said.
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