Article
What the filings show
An analysis of preliminary filings by the Peterson-KFF Health System Tracker, published July 8, found a median proposed increase of 14% among 77 insurers in 16 states and the District of Columbia. If those requests hold, typical marketplace premiums would rise by more than a third between 2025 and 2027. Final rates are not due until late summer, and regulators in some states will cut requests, but the direction is clear.
Insurers point first to higher medical costs, including the price and use of hospital care, physician visits and prescription drugs. Some also cite inflation, labor shortages, higher claims severity and GLP-1 drugs. The end of the enhanced premium tax credits after 2025 is another factor. Healthier people left the market this year once their net premiums jumped, and insurers expect the remaining risk pool to keep getting sicker. Enrollment fell in 2026, and carriers expect another decline in 2027.
Why hospital leaders should care
Exchange enrollees who drop coverage do not stop needing care. They show up later, sicker and often uninsured. Many of those who stay will likely trade down to cheaper plans with higher deductibles, which shifts more of each bill to the patient. Both trends feed bad debt and charity care.
There is also a reputational issue. When filings name hospital prices as a leading driver, they give legislators and employers ammunition in the affordability debate. Expect that framing in state rate hearings and in contract talks with exchange-heavy carriers.
Steps to take this summer
- Size the exposure. Pull exchange volume and payment by plan and metal tier. Model scenarios in which 10% to 20% of these patients lose coverage or shift to bronze plans in 2027.
- Revisit financial assistance. Check whether income thresholds and presumptive eligibility tools will catch patients who fall out of coverage, and make sure front-line staff know how to screen them.
- Tighten point-of-service collections. Price estimates and payment plans matter more when deductibles climb.
- Join the rate review conversation. Work with your state hospital association to present cost data and context before final rates are approved.
- Back enrollment help. Open enrollment starts in the fall. Partnering with navigators and community groups can keep eligible patients covered.
Archive entry for Jul 11, 2026, added Nov. 11, 2026.