Consumers are already feeling the pinch at the grocery store and the gas pump, but those increases are dwarfed by the steep climb in Affordable Care Act (ACA) premiums. New projections suggest the situation is about to get far worse, prompting some to wonder if the program should be renamed the Unaffordable Care Act.
According to a recent Peterson-Kaiser Family Foundation analysis of 276 insurers across all 50 states, the median ACA premium increase for 2027 is expected to hit 15%. Nearly 90 insurers anticipate hikes ranging from 20% to 35% or more—and that comes on top of an already painful 20% jump in 2026. For many enrollees, that translates into cumulative premium increases of 40% to 50% over just two years.
Democrats and much of the mainstream media are quick to pin the blame on President Trump and congressional Republicans. But the evidence points in the other direction. When ObamaCare was passed in 2010, health policy experts—including those who opposed the law—warned that its structure would inevitably lead to rising premiums and shrinking enrollment. Those warnings were dismissed by Democrats who insisted they could bend the insurance market to their will.
Now the consequences are becoming undeniable. Kaiser Family Foundation data reveals that enrollment in the individual health insurance market—where people without employer-based or government coverage buy their own plans—fell 18% between June 2025 and June 2026. That translates to a loss of roughly 4.6 million people out of an estimated 20.5 million enrolled. Kaiser attributes much of this decline to the expiration of enhanced premium tax credits, which had been temporarily boosted by Democrats in 2021.
The exodus is not random. It is being driven by younger and healthier individuals who, even with subsidies, no longer see the coverage as worth the cost. That creates a classic actuarial problem: an insurance pool needs a large number of low-cost enrollees to offset the expenses of the sick. As healthy people drop out, the pool becomes smaller and sicker, forcing premiums even higher—and triggering another wave of departures. That vicious cycle is what industry insiders call a “death spiral.”
Compounding the problem, the Department of Health and Human Services announced in June that it had identified an estimated 2.6 million “improper and phantom enrollments” in the ACA system, including over 1 million without a Social Security number. As these bogus enrollees are purged, their taxpayer-funded subsidies disappear, leaving even less money to cover the growing costs of a sicker, shrinking enrollee base. That development is likely to accelerate the death spiral.
Some Republicans argue that the blame for rising premiums lies not with the party’s refusal to renew enhanced subsidies, but with the law’s fundamental design. The enhanced subsidies, they say, simply masked the true cost of coverage; their expiration merely exposed the underlying price spiral. Democrats counter that without those subsidies, millions of Americans are priced out of care, and they point to the enrollment drop as evidence of the damage.
Can anything stop or reverse the ACA’s death spiral? Short of another infusion of federal cash, probably not. If Democrats regain control of Congress and the White House in 2028, they are almost certain to push for a new round of enhanced subsidies. That would slow the exodus, but only because taxpayers—not the insurance market—would be absorbing most of the cost.
For now, the outlook is grim. As premiums climb and enrollment falls, the ACA risks becoming a small, expensive program serving only the sickest Americans. The political battle over its future is only beginning, and the stakes for millions of policyholders are enormous.
