ACA Signups

Trump's Latest Con is On: Presenting the $500 User Fee Flim-Flam

Charles Gaba — Thu, 10 Sep 2026 20:22:29 +0000

Thu, 09/10/2026 - 4:22pm

Less than 24 hours after making an

RETURNING BIDEN OVERCHARGES TO WORKING FAMILIES: Today, President Donald J. Trump announced that the federal government will return to the American people hundreds of millions in Obamacare overcharges, collected by the Biden Administration, by issuing refunds of $500 per person to nearly 1 million Americans in 30 states. Today’s actions directly refund the Americans most exposed to the higher costs imposed by the Biden Administration’s gross mismanagement of Obamacare.

So what the hell is this all about? Let's take a look, shall we?

The Biden Administration overcharged Americans through Obamacare plan exchange “user fees” that were passed on to consumers in the form of higher premiums, funding the operations of the federal Obamacare exchange far in excess of what was needed to run the exchange.

are a small percentage tacked onto premiums for policies sold through the federal ACA exchange,

In any event, the claim that the Biden Administration "overcharged" for operating the ACA is sheer nonsense. Federal exchange user fees were set to . It was the Biden Administration further reduced the fee to just 2.25% in 2022, and while they did bump it back up to they cut it back down further yet to 2.2% for 2024 and it was the TRUMP Administration which raised the federal user fee keep it at exactly the same 2.5%, although in the the Trump Regime could have simply further reduced the 2027 user fee level accordingly. Instead of 1.9%, they could have further knocked it down to 1.5% or whatever and just used the "excess" money to fill in the gap next year. This would have saved those same full-price payers a few bucks while also, ironically, saving the federal government several hundred million dollars in reduced subsidies.

Of course, all of this assumes that the 2.5% rate was "excessive" to begin with.

President Trump is refunding these excess fees to Americans who do not receive premium assistance under the Unaffordable Care Act – and therefore paid the full cost of Biden’s premium tax – in the 30 states that use the federal exchange for the operations of their Obamacare markets.

In other words, instead of refunding the money to everyone who was supposedly "overcharged" (around 19.2 million Americans as of February 2026, although this has likely dropped by another couple of million people as of today), the vast majority of whom are very low income, the Trump Regime is instead giving ALL of it to just the million or so who aren't receiving federal subsidies this year...the vast majority of whom earn more than 400% of the Federal Poverty Level (FPL), meaning they're basically middle or upper-middle class.

These states include Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Hawaii, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin, and Wyoming.

Did you notice anything about that list? By an amazing coincidence, 15 of the 21 states which operate their own ACA exchanges also happen to be fairly solidly blue states...which means that 26 of the 30 listed above are either red or swing states (DE, HI, NH & OR are the exceptions).

Thanks to President Trump’s actions, nearly 1 million Americans will receive a refund check of $500 per person. Checks will be sent to eligible Americans beginning in October 2026.

Ah yes, just ahead of the midterms. Imagine that.

Here's the true irony of this gimmick by Trump 2.0, however: The very people that he's "offering" a $500 apiece cash "refund" to also happen to be the same people who he and Congressional Republicans just RAISED premiums on by up to $50,000/year this year by letting the enhanced tax credits expire.

LET ME REPEAT THAT: Trump & Congressional Republicans caused premiums for this exact subset of the population to skyrocket by thousands or even tens of thousands of dollars, and is now tossing a one-time $500 payoff at them in return.

Or, as Apocalypse Now put it more crudely, "

In fact, even if you include those still receiving subsidies, on average, ACA enrollees are paying $780 more apiece in premiums this year (largely due to the subsidies expiring)...plus an additional estimated ~$716 in out of pocket expenses. That's nearly $1,500 more per enrollee...and again, for those no longer eligible for federal subsidies the average is much, much higher.

Trump is playing one of the oldest con games in history: He took $100 out of your back pocket and wants you to thank him for putting $10 back in.

But wait...perhaps there's a silver lining? After all, the fact sheet says it's going to "Americans who do not receive premium assistance" which could also include the hundreds of thousands of recent documented, legally-residing immigrants who earn less than 100% FPL who have also had their subsidy eligibility cut off, right?

Wrong, silly! people who earn too much to qualify for an income-based subsidy to lower their health insurance costs" which, by definition, means those who earn over 400% FPL (of course anyone earning less than 100% FPL would never be able to afford to enroll at full price in the first place, much less pay any user fees, which I guess makes this a moot point).

Oh yeah...as you probably already guessed,

User Fees

2027 Rate Changes - Washington: +22.2% indy mkt (FINAL)

Charles Gaba — Thu, 10 Sep 2026 16:59:01 +0000

Thu, 09/10/2026 - 12:59pm

Originally posted 5/29/26

Hoo boy. Thirteen health insurers request average 22.4% rate increase for 2027 individual market

OLYMPIA, Wash. — Thirteen health insurance companies have requested an average rate change of 22.4% for Washington state’s 2027 individual health insurance market. Insurers base requested rate changes on assumptions made about the services their policyholders will use and the cost to deliver that care.

“I know the requested rate changes will be difficult for individuals and families,” said Insurance Commissioner Patty Kuderer. “We’re going to spend the next several months reviewing every assumption made by the insurers to make sure their requests are justified.”

Fourteen insurance companies offered individual plans last year. One of those plans — Providence Health Plan, which had 254 enrollees — will not offer coverage in 2027.

More than 280,000 people in Washington do not receive health insurance through their employer and must buy coverage from the individual market. Nearly 250,000 of them shopped through the Washington Health Benefit Exchange last year. That figure was down 13% from 2025 after Congress failed to renew the Enhanced Advanced Premium Tax credits.

Ninety percent of people buying plans through the Exchange were in a Cascade Care plan in 2026, up from 79% in 2025. Cascade Care plans (standard plans) give Washingtonians a better alternative to health plans with high out-of-pocket costs and a low number of covered services. Cascade Care Savings (state premium assistance) is available through the Exchange for households at or below 250% of the Federal Poverty Level.

The Office of the Insurance Commissioner is currently reviewing the requested changes and will complete its review in September, before open enrollment in November.

ASIRUS NW HEALTH:

4.3: Proposed Rate Changes

This filing proposes an average annual rate change of 14.89% on January 1, 2027, for the Individual line of business, as shown in “Exhibit A1: Development of 2027 Rate Change.” The 2027 projected average premium is $875.38 per member per month (PMPM).

...Based on OIC guidance, only on-exchange Silver plan premium should be increased to cover the additional costs associated with providing benefits to all Silver plan enrollees, in the event the CSR subsidies are not funded. In 2027, ANH is offering plans off-exchange only, and therefore no additional load for CSR has been applied to any plan.

...Reasons for Proposed Rate Change

The following components are the most significant factors contributing to the proposed rate change: medical trend and utilization and financial experience.

Medical Trend and Utilization: These adjustments refer to what is commonly known as healthcare trend. They reflect contractual changes in the payments to healthcare providers and expected changes in the volume and types of services utilized by a carrier’s members.

Financial Experience: Each year ANH evaluates the most recent financial results in the Washington Individual market and incorporates that information into pricing.

Changes in Geographic Factors: ANH evaluates the impact of changes in the rating area factors using current enrollment and incorporates that change into pricing.

Market Morbidity: ANH expects increased market morbidity due to the discontinuance of enhanced Premium Tax Credits as well as increased provider coding activity.

Change in Benefits: Each year ANH evaluates the cost sharing features and benefits of each plan offering to determine the expected cost of incurred claims by plan.

It's worth noting that Asuris doesn't even offer plans on the ACA exchange anyway, so the fact that they still expect there to be "increased morbidity" for their handful of enrollees due specifically to the enhanced federal tax credits expiring is especially telling.

BRIDGESPAN HEALTH:

This filing proposes an average annual rate change of 12.65% on January 1, 2027, for the Individual line of business, as shown in “Exhibit A1: Development of 2027 Rate Change.” The 2027 projected average premium is $1113.77 per member per month (PMPM).

...This filing assumes Cost Sharing Reduction (CSR) payments will not be paid in 2027. If changes are made to the premium subsidies, risk adjustment, or reinsurance, the proposed rates in this filing may need to change materially to ensure adequacy with expected market costs.

...Based on OIC guidance, only on-exchange Silver plan premium should be increased to cover the additional costs associated with providing benefits to all Silver plan enrollees, in the event the CSR subsidies are not funded. See the “CSR Funding” section for more detail.

...Reasons for Proposed Rate Change

The following components are the most significant factors contributing to the proposed rate change: medical trend and utilization and financial experience.

Medical Trend and Utilization: These adjustments refer to what is commonly known as healthcare trend. They reflect contractual changes in the payments to healthcare providers and expected changes in the volume and types of services utilized by a carrier’s members.

Changes in Geographic Factors: ANH evaluates the impact of changes in the rating area factors using current enrollment and incorporates that change into pricing.

Financial Experience: Each year BridgeSpan evaluates the most recent financial results in the Washington Individual market and incorporates that information into pricing. The experience also includes the impacts of pooling BridgeSpan with Regence BlueShield (RBS).

Market Morbidity: BridgeSpan expects increased market morbidity due to the discontinuance of enhanced Premium Tax Credits as well as increased provider coding activity.

Changes in Benefits: Each year, BridgeSpan evaluates the cost sharing features and benefits of each plan offering to determine the expected cost of incurred claims by plan.

If the wording seems familiar, it's because BridgeSpan is actually a subsidiary of COMMUNITY HEALTH PLAN OF WA:

The overall proposed rate change for 2026 across all plans is 24.52%. There are approximately 36,854 members who would receive a rate change to their premiums ranging from -4.3% to 32.8% (for the same age), with rate changes varying by plan and rating area. CHPW is renewing its Complete Gold, Vital Gold, Silver, and Bronze Cascade Select Public Option plans in 2027.

...Changes in medical service costs were driven by expectations for medical inflation (cost per service and utilization of medical and pharmacy services), provider contracting, and care management. Average annual medical/pharmacy inflation of 6.3% is reflected in these rates.

...CHPW will continue to offer the Cascade Select Complete Gold, Vital Gold, Silver, and Bronze plans in plan year 2027. Benefits and member cost-sharing for these plans are set forth by the Washington Health Benefit Exchange. Changes for 2027 include the following. The cost sharing changes below may also impact premium rate changes.

...The enhanced premium subsidies first introduced through the American Rescue Plan Act (ARPA) and later extended by the Inflation Reduction Act (IRA) expired at the end of 2025, resulting in a reduction in the overall market size in 2026. We anticipate further market size reduction in 2027. We assume this will lead to increasing average statewide morbidity in 2027 relative to the 2025 experience period by 2% each year. We anticipate the remaining risk pool in 2027 to have higher healthcare needs, on average, as healthier consumers are more likely to lapse coverage. Given these considerations, we applied a morbidity adjustment to reflect anticipated changes in statewide average morbidity in 2027 relative to 2025. [note: the adjustment for this is 9.7%]

...The WA OIC introduced new Essential Health Benefits to the state benchmark plan for PY2026: Human donor milk, hearing aids and hearing exams, and artificial insemination...We modeled adjustments to projected claims to reflect the anticipated impact of these new essential health benefits. [adjustment: 0.01%]

COORDINATED CARE CORP:

Number of Individuals Impacted by Rate Increase: 97,979 individuals (membership as of March 2026)

The rating structure has not changed from 2026 to 2027; premium rates are developed based on the benefit plan, geographic area, age, and tobacco use of the insured. Premiums are charged for each individual in a family, but for no more than the three oldest dependent children under age 21. The rating factors for benefit plan and geographic area have changed. Age factors have not changed. Tobacco factors have changed to reflect that premiums no longer vary based on tobacco use. Renewing plans in 2027 will see rate changes, which vary depending on the plan selected and the member’s location in the state. The average rate increase is 27.82%.

...The estimated average annual premium per policy in calendar year 2027 is $10,562.

...Impact of eAPTC Expiration: To account for eAPTC expiration prior to the 2027 benefit year, we have assumed rates will increase due to anticipated reductions in enrollment, both at the issuer and single risk pool level. As eAPTCs expire and enrollees subsequently face increased out-of-pocket premiums, we assume healthier individuals who tend to be more price sensitive will leave the market, worsening the average morbidity of the individual risk pool.

Noticing a pattern here?

KAISER FOUNDATION HEALTHCARE PLAN OF THE NORTHWEST:

...The filed overall average premium rate change for January 1, 2027, is 9.5%. We have estimated that premium rate changes by member for those enrolled as of March 2026 will range between 7.69% and 10.90%, including the impact of benefit and cost sharing changes.

...The state of Washington has implemented a 1332 Waiver (1332) which allows formerly ineligible residents access to state funded premium subsidies when enrolled in the Cascade Gold or Cascade Silver On-Exchange plans. The projected impact on membership can be seen in the Individual Supplemental Checklist for 1332 Waiver Reporting and is consistent with the total market growth projections demonstrated in the state’s 1332 application.

This rate filing assumes that the Individual Mandate will continue to be powerless with no replacement provision for the 2027 plan year. Additionally, this rate filing assumes that the Cost Share Reduction (CSR) Subsidies will continue to be un-funded for the 2027 plan year, only people eligible for the 87% and 94% CSR plans will be allowed to enroll in On-Exchange Silver plans and additional plan paid claims costs due to CSR’s will be applied only to the On-Exchange Silver plans.

Side note: This is an important reminder that the federal individual mandate penalty technically still exists on paper...it's just that the amount of the penalty was reduced to $0 or 0.0% of household income back in 2019, so the "penalty" itself is literally nothing.

KAISER FOUNDATION HEALTH PLAN OF WASHINGTON:

...All silver plans oﬀered in the Exchange and only silver plans oﬀered in the Exchange are loaded for cost-share reduction subsidies.

As of March 2026, there were 40,341 enrollees that will be impacted by the 2027 rate change. The average requested rate increase estimated for members enrolled as of March 2026 is 14.03%. The rate increase varies by plan from -19.65% to 18.56%.

...With the proposed rate change, Kaiser Foundation Health Plan of Washington projects an overall loss ratioo percentage of 87.64% and an ACA medical loss ratio (MLR) of 89.6% in 2027. The overall loss ratio is not the same as the 2027 federal MLR. It is calculated as incurred claims / (risk adjustment + premium) and represents the average loss ratio across all products using 2027 projected enrollment for each plan.

Side note: This is an important reminder that while the ACA requires insurance carriers to spend at least 80% of their premium revenue on actual medical claims (and to refund the difference if they come in below that threshold on a 3-year revolving basis), many carriers are spending significantly more than 80% on claims.

...The enhanced premium tax credits that were extended by the Inflation Reduction Act expired at the end of 2025. However, we have included no additional load in the morbidity assumptions in Worksheet 1. For plan year 2026 and 2027, there is a mandated 43.6 percent silver load for on-exchange plans, significantly increasing the premium for the benchmark plan and thereby making bronze and gold plans more affordable for members receiving premium subsidies. Between the increased subsidies and the already low uninsured rate in Washington, our best estimate is that neither the population nor its average morbidity will materially change in plan year 2027.

Note that Kaiser of WA is the first carrier I've seen which specifically says they don't anticipate any further rate hikes to be caused specifically by the tax credit expiration.

LIFEWISE HEALTH PLAN:

LifeWise is in 31 counties and has 25,628 individual members on metallic plans as of March 2026. In 2027, LifeWise will exit King County for all plans.

The average rate increase for 2027 is 21.2%. This is driven by higher medical and pharmacy costs, increased utilization, demographic shifts, benefit design changes, and changes in anticipated risk adjustment transfer dollars.

...Cost-sharing components (including deductibles, copays, coinsurance, and out-of-pocket maximums) for renewing plans have been adjusted to meet the metallic actuarial value (AV) and mental health parity requirements. These types of changes are needed as cost and utilization of health care change every year.

In 2027, the deductible for the LifeWise Essential Gold plan is increasing by $200. For the LifeWise Essential Bronze plan, the deductible is increasing by $200 and the out-of-pocket maximum is increasing by $400.

For the Cascade and Cascade Select plans, deductibles are increasing by the following amounts:

Complete Gold ($700), Vital Gold ($300), Silver ($300), and Bronze ($100). The out-of-pocket maximums are increasing by: Vital Gold ($2,900), Silver ($1,450), and Bronze ($1,650). For the Bronze plan, the mental health office visit copay is increasing by $5.

...In last year’s rate filing, a Morbidity Adjustment of 1.089 was applied. This was to cover the impact of the expiration of the enhanced advanced premium tax credits in 2026, which LifeWise expected to cause healthy people to exit the market or purchase less expensive plans. We now know what plans members purchased in 2026, and we do not expect further deterioration in 2027.

OK, that's another carrier saying the same; sounds like it varies widely depending on how bad the specific carrier anticipated the risk pool damage to be this year.

MOLINA HEALTHCARE OF WASHINGTON:

Molina is requesting on average a 25.84% premium increase for its individual policies sold in the Washington Marketplace effective January 1, 2027. 30,845 Molina Marketplace members would receive changes to their premiums ranging from a 24.24 percent increase to a 26.62 percent increase depending on their geographic location and metal tier. Molina will renew the Molina Cascade Complete Gold, Molina Cascade Silver, and Molina Cascade Bronze plans, and Molina Cascade Vital Gold for 2027. Finally, please note these are averages, by plan and due to members aging, premium changes could be larger or smaller than anticipated.

...Changes in Medical Service Costs: Medical and pharmacy combined trend of 13.8 percent was applied in the development of the rates for expected increases in the utilization and cost of covered services. 4.5 percent of the total trend is due to utilization. 8.8 percent of the total trend is due to unit cost, largely driven by a 19.8% trend in pharmacy drug cost.

...The Molina Cascade Complete Gold plan is being renewed with changes such as deductible from $1000 to $1,700.

The Molina Cascade Silver plan is being renewed with changes to the out-of-pocket maximum on Silver 100, from $2,400 to $4,000, Silver 150, from $2,850 to $4,000, Silver 200, from $7,950 to $9,600, Silver 250 from $9,750 to $11,200.

The Molina Cascade Bronze plan is being renewed with changes to the out-of-pocket maximum from $10,150 to $11,800.

The Molina Cascade Vital Gold plan is being renewed with changes to the out-of-pocket maximum from $8,800 to $11,000

...The morbidity of Molina’s covered population is expected to increase between the experience period and the projection period. Enhanced Premium Tax Credits (ePTCs) expired at the end of 2025. Molina retained Milliman to analyze the impact of expiring premium subsidies on statewide morbidity from 2025 to 2026. We reviewed the study and applied a 1.023 adjustment to the experience to base period acuity adjustment.

PREMERA BLUE CROSS:

Premera is in 10 counties and has 9,639 members on metallic plans as of March 2026. In 2027, Premera will expand to an additional 15 counties, adding coverage in Adams, Asotin, Benton, Columbia, Ferry, Garfield, Grant, Kittitas, Lewis, Pend Orielle, San Juan, Snohomish, Stevens, Walla Walla, and Whitman Counties.

The average rate increase for 2027 is 24.0%. This is driven by higher medical and pharmacy costs, increased utilization, demographic shifts, benefit design changes, and changes in anticipated risk adjustment transfer dollars.

...No Morbidity Adjustment is applied in the 2027 rate development. In last year’s rate filing, a Morbidity Adjustment of 1.050 was applied. This was to cover the impact of the expiration of the enhanced advanced premium tax credits in 2026, which Premera expected to cause healthy people to exit the market or purchase less expensive plans. We now know what plans members purchased in 2026, and we do not expect further deterioration in 2027.

A demographic shift adjustment of 1.159 is made for the expected change in membership demographic between the experience and projection period. This includes the impact of expanding into multiple counties, and development details are in Appendix 2.2.

PROVIDENCE HEALTH PLAN:

As I wrote about last week, Providence Health Plan is shutting down their entire health insurance division across the Northwest. While most of their business is in Oregon, they do have a few hundred ACA enrollees in Washington State as well who will have to shop for new coverage this fall.

REGENCE BLUESHIELD:

Regence BlueShield (Regence) is filing a rate change request for its Individual metallic products. These plans comply with federal Affordable Care Act (ACA) plan design and benefit requirements, and Regence has approximately 16,000 members enrolled in this line of business as of March 2026. Regence is projecting total enrollment for 2027 to be approximately 192,200 member months. This filing is based on claims experience from January 2025 through December 2025, with claims paid through March 2026.

The projected average rate change for plans effective in 2027 is 8.64%, which is an average rate change of about $72 per member per month (pmpm). Because 8.64% (or about $72) is an average, it is possible to have a different rate change. Rate changes vary from about 1.8% to 13.5% and this variability in rate changes is driven by plan design and geographic factor changes. Factors affecting a member's premium are age, family composition, plan, and geographic area. Expected cost differences by product are updated every year to ensure premium differences are appropriate.

...Market Morbidity: RBS expects increased market morbidity due to the discontinuance of enhanced Premium Tax Credits as well as increased provider coding activity.

REGENCE BLUECROSS BLUESHIELD OF OREGON:

The projected average rate change for plans effective in 2027 is 17.37%, which is an average rate change of about $144 per member per month (pmpm). Because 17.37% (or about $144) is an average, it is possible to have a different rate change. Rate changes vary from about 10.9% to 20.9% and this variability in rate changes is driven by plan design and geographic factor changes. Factors affecting a member's premium are age, family composition, plan, and geographic area. Expected cost differences by product are updated every year to ensure premium differences are appropriate.

...Market Morbidity: RBCBSO expects increased market morbidity due to the discontinuance of enhanced Premium Tax Credits.

UNITEDHEALTHCARE OF OREGON:

UHCOR is filing 2027 rates for individual products. The proposed rate change is 26.41% and will affect 6,759 individuals. The rate changes vary between 24.39% and 28.09%. Given that the rate changes are based on the same single risk pool, the rate changes vary by plan due to plan design changes.

...Morbidity Adjustment: The Morbidity Adjustment factor is 1.195 as shown on Worksheet 1 of the URRT.

An adjustment was applied to account for anticipated changes in UHCOR internal morbidity levels. The adjustment was developed by comparing risk scores normalized for demographics and benefits. The factors used in the calculation of the adjustment are consistent with that of the risk adjustment transfer calculation described in Section 4.3.6.

...EXPIRATION OF ENHANCED SUBSIDIES AND OTHER REGULATORY CHANGES

An adjustment was applied to account for the expiration of enhanced premium subsidies passed under the American Rescue Plan Act (ARP) and extended by the Inflation Reduction Act (IRA). Due to the expiration of the enhanced premium subsidies effective 1/1/2026, UHCOR observed a decline in enrollment due to higher post-subsidy premiums. Healthier members are expected to leave at a disproportionately higher rate than those with significant healthcare needs, increasing market morbidity in 2026. This estimate is based on internal modeling using historical Wakely National Risk Adjustment Reporting (WNRAR) data, Marketplace Open Enrollment Period Public Use Files, and Wakely early enrollment reporting for 2026. The adjustment factor is 1.101.

WELLPOINT WASHINGTON:

This submission applies to Wellpoint’s individual market rates available for sale January 1, 2027. The composite rate change proposed in this filing is 13.7%, as shown in Worksheet 2, Section I of the URRT (row 22). Table 2.1 summarizes the significant factors driving the proposed composite rate change effective January 1, 2027.

... An average morbidity adjustment that calibrates the manual experience to expected average morbidity in the Washington individual market. We used CMS risk adjustment reports to derive this adjustment (accounting for the mix underlying Elevance’s 11 manual rate states).

• We anticipate a reduction in the overall market size in 2027 due to the 2026 expiration of the enhanced premium subsidies first introduced through the American Rescue Plan Act (ARPA) and later extended by the Inflation Reduction Act (IRA). This will lead to increasing average statewide morbidity in 2027 relative to the 2025 manual rate experience as consumers will either lose access to subsidies (for those at or above 400% of the Federal Poverty Level) or face higher net premiums due to less generous subsidies. We anticipate the remaining risk pool in 2027 to have higher healthcare needs, on average, as healthier consumers are more likely to lapse coverage. Given these considerations, we apply a morbidity adjustment of 1.031 to reflect anticipated changes in statewide average morbidity in 2027 relative to the manual rate experience.

• An adjustment that reflects the expected morbidity of members that will purchase Wellpoint’s plans (relative to the statewide average morbidity in the Washington individual ACA market). This is derived from historical data Elevance has regarding the morbidity of new members they enroll once entering a new market. This analysis was also used to develop the risk adjustment payment that is projected for 2027.

Add all of this up and Washington's ~280,000 individual market enrollees are looking at seeing gross premiums jump by another 22.4% next year, assuming the preliminary filings are approved as is.

IT'S IMPORTANT TO REITERATE THAT THIS IS FOR UNSUBSIDIZED ENROLLEES ONLY. This year around 64% of ACA exchange enrollees in Washington receive federal subsidies, which amounts to around 55% of the state's total individual market when you include the ~40K or so off-exchange enrollees.

Washington tends to publish annual rate filings for their small group market sometime after their individual market filings are made public, so that'll have to wait.

For what it's worth, here's how effectuated on-exchange enrollment in Illinois has changed by month for every year up through May 2026...

...and here's what that looks like visually, with 2026 compared to 2025 and 2019 (the last pre-COVID/pre-enhanced subsidy year):

UPDATE 9/10/26: The Washington Insurance Dept. has

2027 Rate Changes

Washington State

Tue, 09/08/2026 - 5:27pm
Originally posted 8/06/26

ACA exchange enrollment has dropped by nearly 23% in Alabama since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were already down 4.6% vs. OEP 2025...but

Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:

Looking ahead to 2027, the preliminary rate filings for both the individual and small group markets are now available via the BLUE CROSS BLUE SHIELD OF AL

Scope and Range of the Rate Increase

The average rate increase included in this filing is 19.7%, affecting almost 184,000 members. The main factors driving the need for this increase are:

Alabama market membership loss and remaining members projected to be less healthy during the second year following the end of the enhanced premium subsidies in 2026, which were in place since 2021.

Projected 2026 claim cost trends are higher than projected in the 2026 filing. Higher claim cost trends are projected to continue into 2027.

The premium change experienced by each policyholder will likely differ from the rate increase listed above for the chosen plan because individual and family plan premiums vary based on the age(s) of the individual(s) on the plan, the policyholder’s geographic area, and the number of family members included on the plan as permitted under the ACA.

Enhanced Advance Premium Tax Credits Allowed to Expire for plan year 2026 and later.

Enhanced Advance Premium Tax Credits (enhanced premium subsidies) that were made available in 2021 and 2022 through the American Rescue Plan Act (ARPA) and extended after 2022 by the Inflation Reduction Act (IRA) were allowed to expire by the Federal government and are not available after 2025. As a result of these enhanced premium subsidies, the total Alabama Individual ACA Market grew from 195,000 in 2021 to over 475,000 in 2025. Market membership has dropped below 360,000 YTD in 2026 and is expected to drop further throughout the rest of 2026 and 2027.

Assumptions in this rate filing related to this change:

BCBSAL is projecting that a substantial number of Individual members will leave the Alabama Individual ACA market in 2027, similar to 2026, as enhanced premium subsidies remain unavailable and members are no longer able to afford their out-of-pocket premiums.

Members leaving the market are projected to be healthier than average, which will leave the total Alabama market (or single rating pool) projected to be less healthy in 2027.

Changes in Medical Service Costs

BCBSAL expects per capita claim costs to increase around 5% from 2026 to 2027, mainly due to increasing costs for hospital services and prescription drugs. Hospital costs are expected to grow due to increases in both reimbursement levels and the number of services performed. Prescription drug costs continue to escalate largely due to GLP-1s, new expensive drugs and new covered indications for existing drugs.

Changes in benefits

Overall, changes to benefits in 2027 were minor and generally made to satisfy the Actuarial Value ranges required by law. For 2027, these changes helped to reduce the requested rate change by 3-4%.

Financial Experience of the Product

BCBSAL measures the financial performance of its products using the traditional Medical Loss Ratio (“MLR”) calculation. The MLR is equal to claim costs divided by premium revenue. The target MLR for the Individual market in 2025 was approximately 92%, and actual MLR has emerged at nearly 93%. This means that 8% of premium was needed for non-benefit expenses such as administrative costs, taxes and fees, and contribution to surplus, but only 7% was available after paying benefit expenses.

BCBSAL expects the MLR in 2026 to be nearly 98% mostly due to claims being higher than projected when developing premiums for 2026 where the projected pricing Loss Ratio was approximately 88%.

Based on the rate increases listed above, BCBSAL expects the average MLR for the Individual market to be near the target MLR of about 86% in 2027.

Administrative Cost and Anticipated Margins

Administrative expenses for 2026 have come in as predicted but are expected to increase in 2027 due to overhead expenses being spread over fewer members. Also, this market is perceived to remain volatile, and therefore we have increased our Contribution to Surplus and Risk closer to our historical target for this market of 5%. Finally, 2027 taxes and fees are decreasing nearly 0.7% per CMS’ 2027 Notice of Benefit and Payment Parameters guidance to carriers helping to partially offset the overall increase to rates for 2027.

CELTIC INSURANCE CO

Celtic Insurance Company is filing rates for the individual block of business, effective January 1, 2027. This document is submitted in conjunction with the Part I Unified Rate Review Template and the Part III Actuarial Memorandum.

This information is intended for use by the Alabama Department of Insurance, the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in Alabama to assist in the review of Celtic Insurance Company’s individual rate filing.

The results are actuarial projections. Actual experience will differ for a number of reasons, including population changes, claims experience, and random deviations from assumptions.

In 2025, earned premium was $627.12 per member per month (PMPM). Incurred claims in 2025 were $410.94, or 65.53% of premium. Netting risk adjustment from the claims results in an estimated loss ratio (incurred claims net of estimated risk adjustment transfers, divided by earned premiums) of 69.50%. We expect unit costs to increase for 2027. Further, we have updated underlying experience for the single risk pool, expected administrative expense, and assumptions for federal risk adjustment. These factors, as well as changes to the assumed morbidity of the single risk pool and medical trend, result in a premium rate increase.

Medical trend, or the increase in health care costs over time, is composed of two components: the increase in the unit cost of services and the increase in the utilization of those services. Unit cost increases occur as care providers and their suppliers raise their prices. Utilization increases can occur as people seek more services than before. Additionally, simple services can be replaced with more complex services over time, which is known as service intensity trend. An example of service intensity trend would be the replacement of an X-ray with an MRI scan. Replacing the service with a more intense service causes the total cost of medical services to increase.

The proposed rate change of 11.6% applies to approximately 66,674 individuals. Celtic Insurance Company’s projected administrative expenses for 2027 are $99.25 PMPM. Administrative expense does not include $35.72 for taxes and fees. The historical administrative expenses for 2026 were $83.64 PMPM, which excludes taxes and fees. The projected loss ratio is 83.2% which satisfies the federal minimum loss ratio requirement of 80.0%.

OSCAR INSURANCE CO

1. Scope and Range of Rate Increase

The purpose of this document is to present rate change justification for Oscar Insurance Company (Oscar’s) Individual Affordable Care Act (ACA) products, with an effective date of January 1, 2027, and to comply with the requirements of Section 2794 of the Public Health Service Act as added by Section 1003 of the Patient Protection and Affordable Care Act (ACA).

Using in-force business as of May 2026, the proposed average rate increase for renewing plans is 35.1%. Rate increases vary by plan due to a combination of factors including shifts in benefit leveraging and cost-sharing modifications and network changes. This rate increase is absent of rate changes due to attained age.

The rate increase impacts an estimated 873 members.

2. Reason for Rate Increase(s)

The significant factors driving the proposed rate change include the following:

Medical and Prescription Drug Inflation and Utilization Trends

The projected premium rates reflect the most recent emerging experience which was trended for anticipated changes due to medical and prescription drug inflation and utilization.

Administrative Expenses, Taxes and Fees, and Risk Margin

Changes to the overall premium level are needed because of required changes in federal and state taxes and fees. In addition, there are anticipated changes in both administrative expenses and targeted risk margin.

Prospective Benefit Changes

Plan benefits have been revised as a result of changes in the Center for Medicare and Medicaid Services (CMS) Actuarial Value Calculator and state requirements, as well as for strategic product considerations.

Anticipated Changes in the Average Morbidity of the Covered Population

Changes to the overall premium level are needed because of anticipated changes in the underlying morbidity of the projected marketplace.

Anticipated Changes in the Network Configuration

Changes to the overall premium level are needed because of anticipated changes in the underlying network configuration and associated unit costs.

UNITEDHEALTHCARE INSURANCE CO:

The following memorandum describes the key drivers of the rate changes of individual rates for UnitedHealthcare Insurance Company (“UHIC”). UHIC policies are individual medical plans offered in Alabama and are fully compliant with the Patient Protection and Affordable Care Act.

Scope and Range of the Rate Increase

UHIC is filing 2027 rates for individual products. The proposed rate change is 27.64% and will affect XXX individuals. The rate changes vary between 17.98% and 29.51%. Given that the rate changes are based on the same single risk pool, the rate changes vary by plan due to plan design changes.

Financial Experience of the Product

The premium collected in plan year 2025 was $931,325,284. Incurred claims during this period were $639,766,839 and UHIC expects payments of $105,963,937 for risk adjustment. The loss ratio, or portion of premium required to pay medical claims, for plan year 2025 is 77.51%.

Changes in Medical Service Costs

There are many different healthcare cost trends that contribute to increases in the overall U.S. healthcare spending each year. These trend factors affect health insurance premiums, which can mean a premium rate increase to cover costs. Some of the key healthcare cost trends that have affected this year’s rate actions include:

Increasing cost of medical services: Annual increases in reimbursement rates to healthcare providers, such as hospitals, doctors, and pharmaceutical companies.

Increased utilization: The number of office visits and other services continues to grow. In addition, total healthcare spending will vary by the intensity of care and use of different types of health services. The price of care can be affected using expensive procedures such as surgery versus simply monitoring or providing medications.

Higher costs from deductible leveraging: Healthcare costs continue to rise every year. If deductibles and copayments remain the same, a higher percentage of healthcare costs need to be covered by health insurance premiums each year.

Impact of new technology: Improvements to medical technology and clinical practice often result in the use of more expensive services, leading to increased healthcare spending and utilization.

Reduction of premium subsidies: Expanded and enhanced federal premium tax credits for consumers expired at the end of 2025. As a result, there will be sicker members on average in the insurance pool as healthier members exit the market.

Changes in Benefits

Changes in benefits impact costs and therefore affect premium changes. Plan benefits are typically changed for one of three reasons: to comply with the requirements of the Affordable Care Act or state law, to respond to consumer feedback, or to address a particular medical cost issue to provide greater long-term affordability of the product.

The Affordable Care Act implemented requirements for the “value” that must be offered by plan designs in the Individual and Small Group markets. These are called “metal levels”. For a benefit plan to remain classified within a particular metal level from year to year, adjustments to deductibles, copayments or coinsurance are sometimes required. These adjustments impact the cost and therefore the premium increases for the plan.

Administrative Costs and Anticipated Margins

UHIC works to directly control administrative expenses by adopting better processes and technology and developing programs and innovations that make healthcare more affordable. We have led the marketplace by introducing key innovations that make healthcare services more accessible and affordable for customers, improve the quality and coordination of healthcare services, and help individuals and their physicians make more informed healthcare decisions.

Taxes and fees imposed by the state and federal government are significant factors that impact healthcare spending and must be included as additional administrative costs associated with the plans. These fees include Affordable Care Act taxes and fees which impact health insurance costs and need to be reflected in premium. Another component of premium is margin, which is set to address expected volatility and risk in the market.

The requested rate change is anticipated to be sufficient to cover the projected benefit and administrative costs for the 2027 plan year.

Combined, this amounts to a further 20.7% weighted average rate increase for unsubsidized enrollees, pushing the average per enrollee up to nearly $900 per MONTH.

Meanwhile, Alabama's small group market enrollees are looking at non-weighted average rate increases of 12.5% (I only have the effectuated enrollment for two of the four carriers, and those are the smallest of the four anyway):

UPDATE 9/8/26: On average, rates for BCBS increased 19.9%, rates for UHC increased 27.5%, rates for CIC increased 11.4%, and rates for Oscar increased 33.8%. The actual rates and the supporting material may be found by clicking on the links below.

Consumers with an insurance question may contact the Alabama Department of Insurance, Consumer Services Division, using the contact information below. The Department also maintains a Live Chat feature for consumers at our website at the same 20.7% market-wide:

The press release doesn't mention the final rulings regarding small group market carriers, however.
Alabama
2027 Rate Changes
- Tue, 09/08/2026 - 9:06am
  Originally posted 6/12/26
  
  Individual and Small Group Medical Premium Rates
  
  Beginning with rate application filings submitted in 2023 for benefit year 2024, rate information will be contained in one place for all insurers, separated by Market Segment.
  
  AETNA LIFE:
  
  Aetna is filing revisions to premium rates for Individual Conversion policies that will be sold in New York during 2027. The rates in this filing will apply to Individual Conversion policies that are renewed or sold at policy anniversary beginning on January 1, 2027. These rate changes will impact approximately 30 subscribers and 51 members.
  
  The requested rate changes for Aetna's Individual Conversion policies are directly related to two main drivers: the overall rising cost of health care services in New York, and an adjustment to reflect changes in the type and quantity of medical services used by our members which results in increased claim expenses.
  
  ANTHEM HP:
  
  II. FACTORS CONTRIBUTING TO THE PROPOSED RATE INCREASE
  
  Escalating Health Care Costs
  
  The cost of health care services and equipment continues to be the primary reason for rate increases. A report by Mercer shows health care cost grew by 6.0% in 2025 and projects a sharper increase of 6.7% for 2026, the highest in 15 years.
  
  Health care cost and spending trends reflect underlying changes in the demographics and health status of America’s population. The aging population is driving some of the increase – as people age, they typically utilize more health services. Between 2010 and 2050, the population aged 65 and older is expected to double, as the “baby boomer” population ages and life expectancy continues to rise2 . Indeed, the first baby boomers have now turned seventy and the percentage of workers over 65 is greater than at any period in history. As this population ages it will correspond to a further escalation of costs. Moreover, the country’s general declining health and the increase in obesity and other health concerns, even at younger ages, forces average costs upward.
  
  Hospital
  Hospitals (inpatient and outpatient care) account for the largest share of the health care premium dollar in New York, a percentage that continues to grow. Factors driving this growth include increasing demand for care, rising costs to hospitals of the goods and services needed to provide care, and the growing intensity of care needs.
  
  Prescription Drugs
  Specialty drugs account for one of the biggest health benefit cost drivers. A report by Mercer explains that in 2025, the drug benefit cost per employee rose 9.4%. Additionally, specialty drug trends are expected to increase as more breakthrough gene and cellular products enter the market. 3
  
  American Rescue Plan Act and 1332 Waiver
  The 2027 rate filing reflects the expected impact to the health of the ACA risk pool as well as the financial and membership impacts due to both the expiration of the enhanced ACA premium tax credits under the American Rescue Plan Act as well as the repeal of the 1332 waiver and loss of Medicaid eligibility for certain populations.
  
  Capital District Physicians’ Health Plan:
  
  CDPHP has filed a request for approval to the New York State Department of Financial Services for a change to the premium for this product effective January 1, 2027. Policyholders will receive rate adjustments upon their renewal in 2027. The weighted average premium adjustment is 1.4%. 2,729 members and 1,881 policyholders are affected by this request.
  
  What’s Driving Cost Increases?
  
  While CDPHP and our competitors continue to operate in a challenging and volatile health insurance environment, we are encouraged by meaningful improvement after multiple years of net losses. However, headwinds remain – particularly the disproportionate impact of the Medicare Wage Index on regional, not for profit plans in Upstate New York, along with rising prescription drug and hospital costs, and increasing taxes, fees, and mandates. These realities require continued discipline and focus.
  
  What is CDPHP Doing About It?
  
  To manage rising costs, CDPHP is taking a thoughtful and strategic approach to reducing administrative expenses while maintaining our high standards of service. This includes implementing process improvements, technology enhancements, and operational efficiencies to focus resources where they matter most – delivering value to our members. We’re also taking strategic steps to strengthen our organization through a proposed merger with Excellus Health Plan, Inc., providing important economies of scale and operational efficiencies.
  
  Excellus Health Plan, dba Excellus BlueCross BlueShield • Univeral Healthcare
  
  FACTORS CONTRIBUTING TO THE PROPOSED RATE INCREASE
  
  Escalating health care costs
  The cost of health care services, equipment and products continues to be the primary reason for rate increases. In 2025, the health plan overall spent nearly $7 billion on medical and pharmacy claims, or about $19 million daily.
  
  Medical cost “trend” is a very important consideration in determining the need for a premium rate adjustment. This “trend” is the anticipated change in the cost to treat patients year over year. Upstate New York is not immune to national trends in health care costs given our state’s population and demographics. The trend forecast below takes into account projected increases in costs attributed to what Excellus Health Plan pays out in claims expenses for hospital inpatient and outpatient care, professional services, pharmacy benefits, and other goods and services. The health plan’s anticipated changes in annualized medical benefit spending are summarized as follows:
  
  Hospital inpatient, small group: 8.1% / individual: 7.2%
  
  Hospital outpatient, small group: 11.4% / individual: 14.9%
  
  Professional services, small group: 6.5% / individual: 6.8%
  
  Pharmacy, small group: 9.0% / individual: 15.0%, including:
  
  Specialty Rx, small group: 15.0% / individual: 26.2%
  
  Other medical goods and services, small group: 6.9% / individual: 9.9%
  
  Rising drug prices are having a significant impact on overall medical spending trends. Substantial savings have been achieved over the years with broad acceptance of competitively manufactured generic medicines. However, the savings trend associated with generics is being eclipsed by another trend around the rising cost and utilization of specialty medications including biologics. Every year more and more highly complex specialty medications are approved by the FDA to treat both rare and sometimes more common diseases. Specialty medications are used by approximately 2 percent of our members, but they account for more than 50 percent of total drug spend. Drug trend is a result of both increased utilization and increased unit cost.
  
  Local hospital systems have been challenged financially due to both economic inflationary pressures as well as staffing shortages. Excellus Health Plan has responded to these provider challenges through additional contractual cost increases for our provider systems, resulting in more spending for hospital services. The impact for drug rebate credits and non-system claims’ trends is applied to the base tren
  
  Health Insurance Plan of Greater New York (HIP):
  
  Why do we need to change premiums?
  
  We change premiums due to the rise in the cost of medical care, including the costs of hospital stays, prescription drugs, and other health services. Most of your premium goes toward paying for medical and pharmacy claims for members. In fact, New York State requires that at least 82% of the premium you pay directly covers member medical costs. As the cost and use of pharmacy drugs and medical services go up, so does the cost of medical care we must pay for.
  
  HealthFirst:
  
  Healthfirst is applying for a rate adjustment to account for marketplace trends and to reflect actual and anticipated claims costs. While several market forces continue to drive health care costs higher more generally, Healthfirst continues to strengthen the effectiveness of its care management and quality improvement programs and robust network.
  
  Healthfirst is requesting a higher rate for 2027 because several market forces continue to drive health care costs higher. These forces include:
  
  Cost and utilization increases for inpatient hospital, outpatient hospital, and physician services of approximately 7%.
  
  Cost and utilization increases for prescription drugs, including the increased use of expensive specialty prescriptions of approximately 20%.
  
  Healthfirst has requested an average rate increase of 14.9% for Region 4, which is composed of the five counties of New York City (Bronx, Kings, New York, Queens, Richmond), Rockland County, and Westchester County and for Region 8, which comprises Long Island (Nassau County and Suffolk County)
  
  Highmark Western and Northeastern New York
  
  Over the past three years, the company has incurred approximately $30 million in losses in the individual market. More than 90 cents of every premium dollar—exceeding the state-mandated medical loss ratio—is used to reimburse doctors and hospitals for members’ medical care. This emphasizes the necessity of premium rates that accurately reflect the cost of care.
  
  Despite sustained cost pressures, our stability as a not-for-profit health plan—supported by the strength of Highmark Health—allows us to leverage shared innovation and strategic partnerships to improve efficiency and help mitigate the extent of the proposed 2027 rate increases.
  
  This rate change application affects only the members enrolled in community-rated products for individuals. Based on current membership numbers, we estimate that 2,735 members will be affected by the rate change.
  
  Based on the reasons explained above, we are requesting that the Department of Financial Services grant our submitted premium rate increase of 23.8% for its community-rated individual products to take effect on January 1, 2027. This increase is primarily due to cost and utilization increases.
  
  Independent Health Benefits Corporation
  
  Premium rates tend to rise each year because of the normal inflation of healthcare claim costs. Moreover, in addition to cost increases, utilization of healthcare services also tends to rise as new technologies, services, and prescription drugs are introduced to the marketplace.
  
  For 2027, IHBC is projecting an overall claim expense trend of 14.7%. All else being equal, this would require a corresponding premium rate increase to keep pace with costs. However, because of other factors, IHBC is requesting a rate change lower than the overall claim expense trend.
  
  MVP Health Plan, Inc.
  
  Premium rates are changing due to the following reasons:
  
  The rising cost and utilization of medical services and prescription drugs (+10.1%)
  
  A change in claim projection from the prior year which includes the impact of changes in anticipated payments/receipts in the Federal Risk Adjustment Program (-0.7%)
  
  A change in non-claim expense items including taxes and fees (+1.3%)
  
  MetroPlus Health Plan, Inc.
  
  We are proposing a 17.0% weighted average increase for CY 2027 per member per month premium rates effective 1/1/2027. The rate increase will vary across plans, ranging from 13.7% to 27.3%. The increase will affect 4,113 members (3,614 policyholders). The primary drivers of increases are:
  
  Emerging experience (including risk adjustment, member mix impacts, and Essential Plan members returning to QHPs): 2.8%
  
  Trends due to higher utilization of health care services, higher payments to health care providers, and higher prescription drug costs: 11.3%
  
  Residual impacts of the American Rescue Plan Act subsidies ending: 0.7%
  
  Administrative cost change: -2.3%
  
  Benefits and AV changes: 3.9%
  
  New York Quality Healthcare Corporation (Fidelis)
  
  Fidelis Care’s rate filing is driven by seven primary considerations:
  
  Adjustment from actual to expected experience
  
  Anticipated higher medical and pharmacy costs and increased use of services by our members
  
  Risk Adjustment transfer payment that considers the level of illness of our members
  
  Updates to statewide average morbidity assumptions reflecting population health risk
  
  Changes in prescription drug regulations
  
  The impact of the return of 200–250% FPL members from EP plans to the Individual Market
  
  Changes in the age and gender of those we cover as well as their level of health and wellness
  
  Oscar Insurance:
  
  Why are premiums going up?
  We never base premiums on your age, gender, or health. There are two main reasons for higher premiums: prices for drugs and health care services are on the rise, and members are projected to use more care. When our costs go up, we unfortunately have to raise premiums, as do all other carriers. We expect to pay at least $0.85 of every $1 we collect in premiums towards our members’ medical care, and sometimes we pay even more than that. We use whatever is left to cover the cost of running our business.
  
  United Healthcare Insurance Company of New York, Inc.
  
  A part of the medical costs includes a pooling technique established under the Affordable Care Act (ACA) called Federal Risk Adjustment. This attempts to equalize risk within the New York Individual market and requires carriers to set rates at the statewide average risk level. The estimated risk adjustment value reduces the costs by 26.4% percent.
  
  We have increased the index rate by 0.3% to account for the impact of legislative changes to Behavioral Health Network Adequacy. A rate impact of 0.8% is added for costs associated with the Independent Dispute Resolution process, including both the federal program and additional New York-specific requirements. Additionally, a 2.3% rate impact is attributed expanded coverage for certain prescription drug therapies (including medically necessary GLP-1 medications).
  
  To account for uncertainty related to economic and supply chain conditions and their impact on medical costs, particularly pharmaceuticals, a total price impact of 0.9% is included in the initially submitted rate filing. This estimate may be updated as additional information becomes available. An adjustment of 0.5% was applied to account for the impact of the new proposed premium tax being considered in the NYS Budget.
  
  The impact of the expiration of the American Rescue Plan Act expanded subsidies and the CMS Marketplace Integrity and Affordability Proposed Rule account for 12.7% of the requested rate change.
  
  The requested rate changes also include the impacts of plan relativity changes due to pricing model updates (rate increases or decreases depending on the plan) and benefit changes (rate neutral, increases or decreases depending on the plan). Specific information regarding the benefit changes will be communicated separately to those in impacted plans.
  
  Put them all together and it's not a pretty picture: The weighted average preliminary 2027 rate hikes for the individual market come in at around 21.1% (although NY DFS actually puts it slightly lower, at It's also worth noting that the total enrollment as of spring 2026 including off-exchange enrollees totals less than 194,000 people...even though the official NY State of Health enrollment report puts on-exchange enrollment only as of May 2026 at ~203,000. The only way that makes sense is if if there was a sudden surge in enrollment from March (the as of date most carriers use in their filings) until May...except the NYSoH reports for March & April are also over 200,000, so I'm not sure what to make of the discrepancy.
  
  As a couple of the carrier filings reference, enrollment in the NY ACA exchange market is expected to spike starting in July as up to a whopping ~450,000 New Yorkers are kicked off of the state's Basic Health Plan (BHP) Program due to the GOP's so-called "One Big Beautiful Bill Act," which will also result in a small portion of them becoming eligible for subsidized exchange enrollment instead...which will have a significant impact on the exchange market risk pool.
  
  UPDATE 9/8/26: The New York Dept. of Financial Services has published thechop down the average rate increases dramatically in each:
  
  Department of Financial Services Announces 2027 Health Insurance Premium Rates, Saving New Yorkers $1.6 Billion
  
  Individual Plan Rates Reduced by 71% from Insurers’ Requested Rates, Saving Consumers $324 Million
  
  Small Group Rates Reduced by 66% from Insurers’ Requested Rates, Saving Small Businesses $1.25 Billion
  
  September 4, 2026
  
  The New York State Department of Financial Services today has approved health insurers’ premium rate increases for 2027, saving consumers and small businesses approximately $1.6 billion. In the individual market, DFS reduced insurers’ requested rates to 6.0%, a reduction from 20.6% requested by insurers. In the small group market, DFS reduced insurers’ requested rates to 8.0%, a reduction from 23.7% requested by insurers. Approximately 860,000 New Yorkers are enrolled in individual and small group plans.
  
  The Department is focused on ensuring access to affordable health insurance and delivering meaningful cost savings for New Yorkers. Today’s announcement builds on New York’s efforts to address the rising costs of health insurance. The Governor has taken action to reduce what New Yorkers pay for in preventative and primary care, including eliminating out of pocket costs for insulin, inhalers, and lung cancer screenings.
  
  If my reaction to this seems a bit underwhelmed, it's because New York State has a history of dramatically reducing their approved rate hikes from the preliminary ones. While regulators in many states are known to shave off a point or two here and there for one or two carriers, NY's final rate increases are often cut by half or more:
  
  For 2022, it dropped from 11.1% to 3.7%
  
  For 2023, it dropped from 18.7% to 9.7%
  
  For 2024, it dropped from 22.1% to 12.4%
  
  For 2026, it dropped from 13.2% to 7.1%
  
  I don't know if the insurance carriers in NY are deliberately highballing their projections or what, but the pattern is clear at this point.
  
  There's also another weird New York-specific phenomenon which happened every year from 2013 - 2020: The mysterious "55% Lower" syndrome, which finally came to an end in 2021.
  
  Stranger yet, not only have nearly all of the rate hikes been chopped down dramatically, in some cases they've been cut down to nothing at all (CDPHP, HIP of NY, IHBC and MetroPlus), while in one case it was actually dropped from an 11.3% increase to a 3.1% decrease, which is an extreme rarity this year.
  
  The only thing I can think of which might account for some of this is NY having to significantly shrink their Basic Health Plan (BHP) program, The Essential Plan, which threw nearly half a million low income New Yorkers back into the ACA marketplace mix...but that's been known about for over a year now, and the carriers should have baked any impact from that into their preliminary filings anyway.
  
  In any event, the bottom line is that New York individual market carriers have had their average 2027 rate hikes cut down from 21.1% to just 6.3% by my count, while small group plans (which aren't really impacted by the BHP change anyway) are going from a 25.3% increase to just an 8.0% hike.
  2027 Rate Changes
  New York
  - Fri, 09/04/2026 - 3:41pm
    Originally posted 08/13/2026
    
    Thanks to New Mexico backfilling 100% of ALL lost federal tax credits for EVERY ACA exchange enrollee in the state who was eligible for subsidies last year, their average monthly enrollment total is actually higher than it was in 2025 in spite of Congressional Republicans allowing the enhanced federal subsidies to expire at the end of 2025. Initial signups during Open Enrollment were actually up a whopping 18% vs. OEP 2025.
    
    Even so, effectuated enrollment has still gradually declined over the course of the year so far...from 15% higher year over year in January to just 0.5% higher as of July...and this month it actually slipped slightly below the August 2025 tally (New Mexico is one of a handful of states which provide
    
    Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
    
    Looking ahead to 2027, the preliminary rate filings for both the individual and small group markets are now available via the Blue Cross Blue Shield of NM (Health Care Service Corp):
    
    Blue Cross and Blue Shield of New Mexico (BCBSNM) is filing new rates to be effective January 1, 2027, for its Individual ACA metallic coverage. As measured in the Unified Rate Review Template (URRT), the range of rate changes for these plans is an increase of 27.4% to an increase of 33.1%. The following is the average rate increase:
    
    Product Rate Increase: Blue Community 29.05%
    
    The cost relativities among plans are different from the experience period to the prospective rating period due to anticipated non-uniform changes in network reimbursement levels. Additionally, the rates vary by plan due to the leveraging and utilization differences driven by variations in member cost sharing. Therefore, the proposed rates and rate changes may vary by plan. Changes in allowable rating factors, such as age and geographical area, may also impact the premium amount for the coverage.
    
    There are currently 40,188 members on Individual Affordable Care Act (ACA) plans that may be affected by these proposed rates.
    
    Financial Experience of the Product
    
    Consistent with the filed URRT, earned premiums for Individual plans during calendar year 2025 were $270,562,976 and total claims incurred were $310,362,719. The proposed rates effective January 1, 2027, are expected to achieve the loss ratio assumed in the rate development.
    
    Changes in Medical Service Costs
    
    The proposed rates reflect expected change in year over year medical service and prescription drug costs, which includes changes in reimbursement rates to providers, changes in expected utilization of services, the mix and intensity of services, and the introduction of new procedures and technologies.
    
    Changes in Benefits
    
    Cost-sharing changes were made within these products allowing plans to maintain their metal status and to comply with 2027 Plan Year Standardized Health Plan requirements prescribed by the BeWell Board of Directors, which can contribute to the change in rates.
    
    State Mandated Changes
    
    The proposed rates reflect the impact of New Mexico legislation items and/or regulatory changes effective on January 1, 2027. In accordance with state regulation, we have applied a CSR defunding adjustment to on-Exchange silver plans which reflects the expected cost and mix of enrollment in CSR plan variants and excludes health status.
    
    Plan offerings comply with 2027 Plan Year Individual QHP and Small Group Market Rate Filing Guidance to set the tobacco rating multiplier at 1.0 for all individual on-and-off-exchange plans, offer only two on-exchange non-standardized Silver and Gold plans in any rating area, and keep the minimum premium differential for a 21-year-old between any two non-standardized silver plans in a single area above $10 PMPM.
    
    In addition, Turquoise variants are made available for each Silver and Gold plan with Turquoise 3 eligibility to 200-400% FPL and the -13 variant for Native Americans between 300-400% FPL and participate in Gold plans, as mandated by the Health Insurance Marketplace Affordability Program Policy and Procedures Manual.
    
    Administrative Costs and Anticipated Margins
    
    The Affordable Care Act expects health plans in the individual market to spend at least 80% of each premium dollar they collect to pay for medical care and activities that improve health care quality for members. If health plans fail to spend at least 80% on medical claims and health care quality initiatives, they are required to give back money to consumers through a premium rebate. These rates assume BCBSNM will once again exceed the 80% threshold.
    
    Molina Healthcare of NM:
    
    Molina Healthcare of New Mexico, Inc. is a managed care organization that provides healthcare services to individuals eligible for Medicaid, Medicare, and Marketplace throughout the State of New Mexico. Molina Healthcare of New Mexico, Inc. is a licensed state health plan managed by its parent corporation, Molina Healthcare, Inc.
    
    1. Scope and range of the rate increase: Molina’s proposed rates represent an average rate increase of 30.4% for the 18,174 Molina members enrolled in continuing plans effective March 2026. The proposed rate changes vary by metal tier. Members would receive premium increases of approximately 30.4% depending on their geographic location, metal tier, and age.
    
    2. Financial experience of the product: The proposed premium rates yield a medical loss ratio of 87.3%. The medical loss ratio represents the percentage of every premium dollar that Molina expects to spend on medical expenses and improving health care quality for our members. The projected medical loss ratio of 87.3% exceeds the Affordable Care Act minimum required loss ratio of 80.0%.
    
    3. Changes in Medical Service Costs: Medical inflation related to the utilization and cost of covered services increased claims by 10.2%. Trend is one of the primary contributors to an increase in rates. Changes in provider contracting rates also contributes to the regional rate changes.
    
    4. Changes in Benefits: Molina is renewing 2 gold and 1 silver plan offering from 2026, and introducing one new silver plan and one new bronze plan offering. Benefit changes by plan are summarized below for renewing plans with projected membership in PY2027.
    
    The Turquoise 1 variant of the Clear Cost Silver plan design’s individual calendar year maximum out of pocket is increasing from $250 to $300. Additionally, copays on Specialist visits, laboratory services, imaging and skilled nursing facility are increasing from $3 to $5. Copays on outpatient facility services are increasing from $5 to $10. Copays on all inpatient hospital services and emergency room services are increasing from $30 to $35.
    
    The Turquoise 2 variant of the Clear Cost Silver plan design’s individual calendar year deductible and maximum out of pocket amounts are increasing from $200 to $400 and from $1,200 to $1,400, respectively. Additionally, copays on primary care visits are increasing from $5 to $10. Copays on Specialist visits, laboratory services, imaging and skilled nursing facility are increasing from $10 to $20. Copays on outpatient facility services are increasing from $35 to $45. Copays on all inpatient hospital services and emergency room services are increasing from $40 to $55. Prescription copays are increasing from $3 to $10 for generic, $10 to $20 for preferred brand, and $50 to $55 for non-preferred brand drugs.
    
    The Turquoise 3 variant of the Clear Cost Gold plan design’s individual calendar year deductible and maximum out of pocket amounts are increasing from $700 to $1,350 and from $2,800 to $3,600, 1respectively. Additionally, copays on primary care visits are increasing from $7 to $15. Copays on Specialist visits, laboratory services, imaging and skilled nursing facility are increasing from $20 to $30. Copays on outpatient facility services are increasing from $60 to $90. Copays on all inpatient hospital services and emergency room services are increasing from $75 to $100. Prescription copays are increasing from $5 to $15 on generics and $10 to $30 on preferred brand drugs.
    
    The Clear Cost Gold plan design’s individual calendar year deductible and maximum out of pocket amounts are increasing from $3,000 to $3,850 and from $6,000 to $6,850, respectively. No other cost sharing is changing for this plan.
    
    The Turquoise 3 variant of the Molina Gold Low Cost Generic Rx plan design’s individual calendar year deductible and maximum out of pocket amounts are increasing from $500 to $900 and from $3,000 to $4,000, respectively. Additionally, copays on Specialist visits are increasing from $25 to $30, copays on urgent care visits are increasing from $10 to $20 and copays on speech, occupational, and physical therapy are increasing from $10 to $30. The copays, after deductible, on preferred brand and non-preferred generic drugs are decreasing from $35 to $25. Default coinsurance on medical services subject to coinsurance is increasing from 10% to 25%. Coinsurance levels on preferred specialty drugs, non-preferred brand drugs and non-preferred specialty drugs are increasing from 15% to 40%, 18% to 30%, and 20% to 50%, respectively.
    
    The Molina Gold Low Cost Generic Rx plan design’s individual calendar year deductible and maximum out of pocket amounts are not changing. Copays on urgent care visits are increasing from $20 to $40 and copays on speech, occupational, and physical therapy are increasing from $20 to $50. The copay on preferred generic drugs is decreasing from $15 to $10. Coinsurance levels on preferred specialty drugs, non-preferred brand drugs and non-preferred specialty drugs are increasing from 25% to 40%, 28% to 35%, and 30% to 50%, respectively.
    
    Benefit changes were implemented to comply with allowable actuarial value ranges by metallic offering using the PY2027 federal actuarial value calculator. The increases in member cost sharing serve to reduce the plan actuarial values used in pricing, putting downward pressure on rates and dampening the overall rate change. The newly offered Molina Silver Low Cost Generic Rx and Molina Bronzer Saver plans also offer lower actuarial value, lower relative premium options in the market.
    
    5. Administrative Costs and Anticipated Profits: Total administrative expenses are expected to increase compared to 2026, contributing to a increase in rates of approximately 3.8%, primarily due to an increase in per member per month corporate expense. Targeted profit margin remains the same as the prior year’s rate filing.
    
    Presbyterian Health Plans:
    
    Presbyterian Health Plan (PHP) is filing rates for the Individual block of business, effective 1/1/2027. This document is submitted in conjunction with the Part I Unified Rate Review Template and the Part III Actuarial Memorandum. This information is intended for use by the New Mexico Office of the Superintendent of Insurance (OSI), the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in order to assist in the review of PHP’s Individual rate filing. This information may not be appropriate for other purposes. Milliman makes no representations or warranties regarding the contents of this letter to other users. Likewise, other users of this letter should not place reliance upon this actuarial memorandum that would result in the creation of any duty or liability for Milliman under any theory of law.
    
    The results are actuarial projections. Actual experience will differ for a number of reasons, including population changes, claims experience, and random deviations from assumptions.
    
    We have calculated an overall rate change of 14.6% from the rates effective 1/1/2026 to the rates effective 1/1/2027. In pricing Individual products for 2027, we have updated underlying experience for the latest experience of the single risk pool (CY2025), updated projected rebates received for prescription drugs, updated administrative expense projections, updated assumptions for federal risk adjustment, updated network savings, and provider reimbursement information. All of these factors contribute to the premium rate change. The proposed rate change of 14.6% applies to approximately 18,699 individuals as of March 2026. Actual increases for any particular contract holder will vary based on plan and network.
    
    In 2025, earned premium was $617.15 per member per month (PMPM). Incurred claims in 2025 after accounting for rebates and the state SOPA payment were $617.25, or 100.0% of premium. After adjusting for risk adjustment, the estimated 2025 claim-to-premium ratio was 100.9%. Differences between the underlying 2025 claims cost (before rebates, utilization management, and SOPA payments) compared to the experience projected for 2025 in the 2026 rate filing account for 10.9% of the overall rate increase.
    
    Medical trend, or the increase in health care costs over time, is composed of two components: the increase in the unit cost of services and the increase in the utilization of those services. Unit cost increases occur as care providers and their suppliers raise their prices. Utilization increases can occur as people seek more services than before. Additionally, simple services can be replaced with more complex services over time, which is known as service intensity trend. An example of service intensity trend would be the replacement of an X-ray with an MRI scan. Replacing the service with a more intense service causes the total cost of medical services to increase. An additional year of total trend from 2026 to 2027 accounts for approximately 9.0% of the overall rate increase.
    
    In addition to the above,
    
    1) Presbyterian administrative cost allocated to the individual product has increased in the 2027 filing relative to the 2026 filing. This is driven by changes in the membership mix across products resulting in reallocation of fixed costs from other products to the individual product.
    
    2) Presbyterian had implemented several programs intended to reduce utilization and lower costs in 2025 that were incorporated into the 2026 filing but has fewer programs in place projected to result in savings for 2026 and 2027. Together, these contribute toward a 0.8% increase in premium relative to what was assumed for the 2026 filing.
    
    3) Presbyterian’s risk adjustment transfer in 2025 is projected to be a smaller payable compared to what was 2024. The 2027 filing starts from the 2025 risk adjustment as the basis for the projection, resulting in a lower projected risk adjustment transfer payable. This results in a decrease in premium of 0.9%.
    
    4) Presbyterian is changing benefits and network for plans in 2027 and is expected to have different mix of members, resulting in a decrease in premium of 9.4%. The projected loss ratio is 83.7% after accounting for taxes and fees, which satisfies the federal minimum loss ratio requirement of 80.0%.
    
    UnitedHealthcare of NM, Inc:
    
    UHCNM is filing 2027 rates for individual products. The proposed rate change is 23.69% and will affect 9,219 individuals. The rate changes vary between 11.45% and 32.28%. Given that the rate changes are based on the same single risk pool, the rate changes vary by plan due to plan design changes.
    
    Financial Experience of the Product
    
    The premium collected in plan year 2025 was $110,914,474. Incurred claims during this period were $135,398,739 and UHCNM expects payments of $2,966,941 for risk adjustment. The loss ratio, or portion of premium required to pay medical claims, for plan year 2025 is 124.75%.
    
    Changes in Medical Service Costs
    
    There are many different healthcare cost trends that contribute to increases in the overall U.S. healthcare spending each year. These trend factors affect health insurance premiums, which can mean a premium rate increase to cover costs. Some of the key healthcare cost trends that have affected this year’s rate actions include:
    
    Increasing cost of medical services [3.2%]: Annual increases in reimbursement rates to healthcare providers, such as hospitals, doctors, and pharmaceutical companies.
    
    Increased utilization [7.5%]: The number of office visits and other services continues to grow. In addition, total healthcare spending will vary by the intensity of care and use of different types of health services. The price of care can be affected using expensive procedures such as surgery versus simply monitoring or providing medications.
    
    Higher costs from deductible leveraging: Healthcare costs continue to rise every year. If deductibles and copayments remain the same, a higher percentage of healthcare costs need to be covered by health insurance premiums each year.
    
    Impact of new technology: Improvements to medical technology and clinical practice often result in the use of more expensive services, leading to increased healthcare spending and utilization.
    
    Changes in Benefits
    
    Changes in benefits impact costs and therefore affect premium changes. Plan benefits are typically changed for one of three reasons: to comply with the requirements of the Affordable Care Act or state law, to respond to consumer feedback, or to address a particular medical cost issue to provide greater long-term affordability of the product.
    
    The Affordable Care Act implemented requirements for the “value” that must be offered by plan designs in the Individual and Small Group markets. These are called “metal levels.” For a benefit plan to remain classified within a particular metal level from year to year, adjustments to deductibles, copayments or coinsurance are sometimes required. These adjustments impact the cost and therefore the premium increases for the plan.
    
    Administrative Costs and Anticipated Margins
    
    UHCNM works to directly control administrative expenses by adopting better processes and technology and developing programs and innovations that make healthcare more affordable. We have led the marketplace by introducing key innovations that make healthcare services more accessible and affordable for customers, improve the quality and coordination of healthcare services, and help individuals and their physicians make more informed healthcare decisions.
    
    Taxes and fees imposed by the state and federal government are significant factors that impact healthcare spending and must be included as additional administrative costs associated with the plans. These fees include Affordable Care Act taxes and fees which impact health insurance costs and need to be reflected in premium. Another component of premium is margin, which is set to address expected volatility and risk in the market.
    
    The requested rate change is anticipated to be sufficient to cover the projected benefit and administrative costs for the 2027 plan year.
    
    Combined, the four New Mexico carriers are asking for premium increases averaging a whopping 25.6% for 2027...pushing the average for unsubsidized enrollees up to over $1,000/month:
    
    Meanwhile, the New Mexico small group market is looking at an average rate increase of 20.2%:
    
    UPDATE 9/4/26: Via the sold on and off BeWell, the New Mexico Health Insurance Marketplace. The average increase is 24.4%; OSI scrutinized the rates and they are actuarially sound, as required by federal and state laws.
    
    “Rising health care costs and inflation are continuing to affect consumers nationwide and New Mexico is no different. Despite the rate increase, I can assure you that the rates for all the insurance companies are actuarially sound, non-discriminatory, and transparent,” said Superintendent of Insurance Alice Kane.
    
    The rate increase is higher than the nationwide median of 15%. New Mexico’s premiums, however, have historically been lower than most other states. The rate increase and historically lower premiums result in premiums that are now in line with the rest of the nation before subsidy assistance. It is important to note that 92% of BeWell enrollees are eligible for state and federal premium subsidies based on income.
    
    New Mexico’s Health Care Affordability Fund (HCAF) will continue to provide financial assistance to eligible New Mexicans. In 2027, the HCAF is expected to provide ongoing premium and cost-sharing relief for BeWell enrollees, helping to mitigate the impact of the rate increase. Federal and state premium assistance will continue to play a significant role in safeguarding the affordability of health insurance.
    
    Our state’s uniquely comprehensive benefits such as behavioral health services and prior authorization prohibitions contribute to the rate increases. Insurance companies cannot charge cost-sharing for in-network behavioral health services or require prior authorization for certain behavioral health services. Removing cost-sharing and prior authorization requirements promotes utilization, which initially increases premiums but will save costs and improve overall health outcomes in the long-term.
    
    The key factors that contributed to the rate increase this year include:
    
    Higher than expected 2025 New Mexico claims experience, which is the foundation for the 2027 rate development;
    
    Higher utilization and inflation impacted healthcare costs services, which impacts medical services and pharmaceutical costs nationwide; and
    
    Upward trending of brand name drugs and biologicals, which often provide advanced therapies, comprised 85% of overall drugs costs in New Mexico.
    
    Turquoise Plans continue to provide additional savings on deductibles and co-pays. Standardized “Clear Cost” plans also continue to be offered and feature consistent costsharing structures, regardless of the insurance company, making it easier for BeWell enrollees to compare plans.
    
    During the open enrollment period from November 1 to January 15, BeWell enrollees can schedule an appointment at bewellnm.com/appointment and have a certified assister guide them through finding a plan that is right for their needs.
    
    BeWell Resources:
    
    Visit
    The rates take effect on January 1, 2027. The insurance companies offering coverage in New Mexico will remain the same: Health Care Service Corporation (dba BCBS NM), Presbyterian Health Plan, United Healthcare of New Mexico, and Molina Health Care of New Mexico.
    
    Unfortunately the NM OSI hasn't posted final/approved 2027 rates for the small group market yet, but I'll update this post again when those come out.
    
    New Mexico
    2027 Rate Changes
    Fri, 09/04/2026 - 2:50pm
    Originally posted 06/05/2026
    
    . As part of CID’s statutory responsibilities, the CID will conduct a thorough and careful review of each filing to ensure compliance with Connecticut insurance laws and regulations.
    
    The CID’s review process will examine each submission in detail, requiring insurers to provide justifications and supporting evidence for their requested rates. or submit them by mail to the Connecticut Insurance Department at P.O. Box 816, Hartford, CT 06142-0816.
    
    The CID will hold a public informational session on the requested rate filings in August, and members of the public will have an opportunity to speak. The date and time will be announced once finalized.
    
    Open enrollment for the 2027 coverage year will begin in the Fall of 2026, consistent with prior years.
    
    Via the filing summaries, it looks like ConnectiCare has dropped their ConnectiCare Inc. division (which only had around 700 enrollees a year ago anyway) on the individual market, while All plan(s) are new. The rate increase is not applicable due to the lack of direct comparison of the current plans and the new plan(s).
    
    If approved, the new rates would take effect January 1, 2027.
    
    In any event, average unsubsidized 2027 premiums for the individual market are going up a requested average of 15.7%, while the small group market carriers are asking for a 17.8% hike.
    
    UPDATE 9/4/26: The Connecticut Insurance Dept. has published the f+11.2%. For the latter, they also shaved a couple of points off; the weighted average increase dropped from 17.8% to 15.1%.
    
    Connecticut
    2027 Rate Changes
    Anthem
    ConnectiCare
    Fri, 09/04/2026 - 11:29am
    Originally posted 6/19/26
    
    The first thing that's important to understand about the Indiana insurance market is that there are two carriers leaving the individual (ACA) market, and one possibly (?) leaving the small group market next year.
    
    I had previously written about Cigna Health & Life Insurance pulling completely out of the ACA market across all states in 2027. In Indiana, Cigna only had around 8,600 ACA enrollees last year; this year, along with at least some other states as well. Again, , that puts Indiana's total current individual market size at around 256,000 people, which includes both on & off-exchange enrollees.
    
    This is pretty concerning considering that that just over 300,000 Hoosiers signed up for coverage during the 2026 Open Enrollment Period...which itself was already down 59,000 from the 2025 OEP.
    
    Even if you assume that only 6% of the enrollees are off-exchange, that still means that net effectuated ACA enrollment was likely down to perhaps ~240,000 as of March...which would be a 20% drop from OEP and a 16% drop vs. the same point a year earlier. Ouch.
    
    Of course, this shouldn't be surprising given that net premiums skyrocketed by 85% this year for Indiana enrollees, due almost entirely to Congressional Republicans and the Trump Regime allowing the enhanced federal subsidies to expire back in December.
    
    In any event, the resulting worsening of the risk pool, combined with other factors, has led Indiana individual market carriers to put in preliminary weighted average rate increase requests of 18.9% for 2027. If approved as is, that would mean unsubsidized enrollees would have to pay a whopping ~$1,400 more in premiums alone next year.
    
    The only positive news is that there appears to be one carrier newly entering the Indiana market: AmeriHealth Caritas:
    
    Anthem Insurance Companies, Inc. (also referred to as Anthem) has made an application to the Indiana Department of Insurance for premium rate changes for its fully ACA-compliant individual health plan products. This rate change will impact approximately 102,400 current Indiana insured members renewing in 2027 with Anthem. This filing includes an average rate change of 15.6%, excluding the impact of aging, effective January 1, 2027. At the individual plan level, rate changes range from 11.9% to 29.6%. An individual’s actual rate could be higher or lower depending on the geographic location, age characteristics, dependent coverage and other factors.
    
    Financial Experience
    
    Anthem expects the proposed rate change will cover projected medical trends and yield a medical loss ratio of 83.6%, meaning more than eighty-three cents of each premium dollar are expected to go to covering our members’ medical expenses and improving health care quality. This projected MLR of 83.6% exceeds the minimum MLR requirement of 80% as defined in the Affordable Care Act (ACA). In the event Anthem’s MLR is less than the Federal required minimum for a three year period, Anthem will refund the difference to policyholders, consistent with federal regulations.
    
    Drivers of Rate Increase
    
    One driver of premium rate changes is associated with the increased cost of benefit expense for this ACA compliant block. Increased cost of benefit expense is driven by increases in the price of services primarily from hospitals, physicians and pharmacies, coupled with members increasing their use of health care services, also called “utilization”. Increases in the price of services are driven by technological advances, new specialty medications, and a variety of other factors. Increased utilization is driven by member level utilization and selection patterns in the Guaranteed Issue, Community Rated ACA market.
    
    Celtic Insurance Company is filing rates for the individual block of business, effective January 1, 2027. This document is submitted in conjunction with the Part I Unified Rate Review Template and the Part III Actuarial Memorandum.
    
    This information is intended for use by the Indiana Department of Insurance, the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in Indiana to assist in the review of Celtic Insurance Company’s individual rate filing.
    
    The results are actuarial projections. Actual experience will differ for a number of reasons, including population changes, claims experience, and random deviations from assumptions. In 2025, earned premium was $521.76 per member per month (PMPM). Incurred claims in 2025 were $388.19, or 74.40% of premium. Netting risk adjustment from the claims results in an estimated loss ratio (incurred claims net of estimated risk adjustment transfers, divided by earned premiums) of 83.62%. We expect unit costs to increase for 2027. Further, we have updated underlying experience for the single risk pool, expected administrative expense, and assumptions for federal risk adjustment. These factors, as well as changes to the assumed morbidity of the single risk pool and medical trend, result in a premium rate increase.
    
    Medical trend, or the increase in health care costs over time, is composed of two components: the increase in the unit cost of services and the increase in the utilization of those services. Unit cost increases occur as care providers and their suppliers raise their prices. Utilization increases can occur as people seek more services than before. Additionally, simple services can be replaced with more complex services over time, which is known as service intensity trend. An example of service intensity trend would be the replacement of an X-ray with an MRI scan. Replacing the service with a more intense service causes the total cost of medical services to increase.
    
    The proposed rate change of 15.3% applies to approximately 18,073 individuals. Celtic Insurance Company’s projected administrative expenses for 2027 are $107.69 PMPM. Administrative expense does not include $10.13 for taxes and fees. The historical administrative expenses for 2026 were $78.61 PMPM, which excludes taxes and fees. The projected loss ratio is 85.6% which satisfies the federal minimum loss ratio requirement of 80.0%.
    
    Coordinated Care Corporation is filing rates for the individual block of business, effective January 1, 2027. This document is submitted in conjunction with the Part I Unified Rate Review Template and the Part III Actuarial Memorandum.
    
    This information is intended for use by the Indiana Department of Insurance, the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in Indiana to assist in the review of Coordinated Care Corporation’s individual rate filing. The results are actuarial projections. Actual experience will differ for a number of reasons, including population changes, claims experience, and random deviations from assumptions.
    
    In 2025, earned premium was $506.31 per member per month (PMPM). Incurred claims in 2025 were $482.33, or 95.26% of premium. Netting risk adjustment from the claims results in an estimated loss ratio (incurred claims net of estimated risk adjustment transfers, divided by earned premiums) of 93.57%. We expect unit costs to increase for 2027. Further, we have updated underlying experience for the single risk pool, expected administrative expense, and assumptions for federal risk adjustment. These factors, as well as changes to the assumed morbidity of the single risk pool and medical trend, result in a premium rate increase.
    
    Medical trend, or the increase in health care costs over time, is composed of two components: the increase in the unit cost of services and the increase in the utilization of those services. Unit cost increases occur as care providers and their suppliers raise their prices. Utilization increases can occur as people seek more services than before. Additionally, simple services can be replaced with more complex services over time, which is known as service intensity trend. An example of service intensity trend would be the replacement of an X-ray with an MRI scan. Replacing the service with a more intense service causes the total cost of medical services to increase.
    
    The proposed rate change of 25.2% applies to approximately 63,592 individuals. Coordinated Care Corporation’s projected administrative expenses for 2027 are $101.70 PMPM. Administrative expense does not include $16.14 for taxes and fees. The historical administrative expenses for 2026 were $86.75 PMPM, which excludes taxes and fees. The projected loss ratio is 85.0% which satisfies the federal minimum loss ratio requirement of 80.0%
    
    UHIC will sell Individual policies with an effective date of January 1, 2027. The 2027 aggregate rate change as shown on the Unified Rate Review Template (URRT) is 32.44%. The rate change by product is 32.23% for UHC IND EPO and 32.86% for UHC IND EPO ADAV. Rate changes by plan are found in Worksheet 2, row 1.11 of the URRT. The quantitative impact for all significant factors driving the proposed rate change is shown in the table below. There might be small differences compared to the URRT due to rounding error.
    
    Components of Rate Change
    
    Single Risk Pool Experience 10.9%
    
    Medical Inflation -1.4%
    
    Increased Utilization 4.7%
    
    Administrative Expenses 6.8%
    
    Market Morbidity 6.8%
    
    Other 1.4%
    
    Total 32.4%
    
    Given that the rate changes are based on the same single risk pool, the rate changes vary by plan due to plan design changes. Additional detail is provided below describing the significant adjustments driving the proposed rate change.
    
    Single Risk Pool Experience reflects actual emerging experience relative to that assumed in the development of PY2026 rates. Experience was more adverse than anticipated, contributing to upward pressure on rates.
    
    Medical Inflation represents the impact of changes in projected unit cost trends for medical services, including changes in reimbursement levels.
    
    Increased Utilization captures changes in the expected frequency and intensity of services utilized by members, independent of unit cost trends.
    
    Administrative Costs reflects changes in administrative costs, including taxes, fees, and other non-benefit expenses, from PY2026 to PY2027.
    
    Market Morbidity represents the projected shift in the underlying risk profile of the covered population. This includes an anticipated reduction in enrollment among healthier, lower-utilizing members and a corresponding increase in the proportion of higher-risk members. The morbidity impact also reflects expected effects of regulatory changes, including reduced subsidy eligibility for certain populations.
    
    Other reflects any changes to the rates not already captured above.
    
    As for the small group market, I only found filings for five of the six carriers participating this year. I don't know whether Integon National is leaving the market or not (I can't find any evidence either way), but they only had around 1,000 enrollees last year. The remaining five are asking for weighted increases of 14.4%.
    
    UPDATE 9/4/26: The Indiana Dept. of Insurance has published the 17.1%, while small group plans were approved pretty much as is, with the weighted average increase being bumped up from 14.4% to 14.5%.
    
    2027 Rate Changes
    Indiana
    Fri, 09/04/2026 - 11:18am
    Originally posted 06/11/2026
    
    Blue Cross Blue Shield of Massachusetts HMO Blue, Inc.
    
    Costs for medical care and medications for our members have escalated rapidly and spending is now growing at the fastest rate in more than a decade. The surge in spending is putting a heavy burden on our employer customers and members who are struggling to keep up with rising costs.
    
    We’ve seen use and severity trend accelerate through the end of 2025. This is not an anomaly, but rather reflects observable, sustained increases in underlying medical utilization and severity identified by our Trend Analytics Team. We are experiencing persistent utilization pressures across multiple service categories, most notably in outpatient surgeries (including digestive and cardiovascular surgeries), rising behavioral health visit volumes, and increased medical pharmacy use.
    
    We have also observed and measured an increase in the severity component of trend. We have measured the impact of changes in the way providers are billing both inpatient and outpatient services to increase provider revenue with no appreciable difference in the way care is delivered. As recent state reports have found, hospital and pharmaceutical costs continue to be the two largest categories of medical spending increases across Massachusetts. The effects of inflation and labor shortages have led to large price increase requests from healthcare providers. Additionally, more than 30% of total medical expense trend is driven by pharmaceutical costs.
    
    The impact of blockbuster high-cost biologics, and other innovative emerging therapies has a material impact on current trends. These dynamics put added pressure on medical claims, which in turn causes premiums to increase.
    
    There are several other factors that drive medical spending, including the proliferation of new and expensive technology, an aging population, and the increased utilization of expensive specialty drugs.
    
    Boston Medical Center Health Plan, Inc. (BMCHP) d/b/a WellSense Health Plan (WellSense)
    
    The overall average annual premium rate change is 11.9%, which is driven by the factors outlined below:
    
    Higher medical and pharmacy Trend:
    
    Medical costs continue to increase, partly due to provider contracting dynamics. Providers often seek higher reimbursement for ACA commercial plans to offset lower government-mandated rates from public programs.
    
    In addition, the Connector’s 2024 Seal of Approval requirement to align provider networks across metal tiers has increased WellSense’s provider costs. Changes to certain subsidized ConnectorCare plans in 2026 have also shifted members into products with higher reimbursement levels, further contributing to cost increases.
    
    Behavioral health, while still a smaller share of total spending, has experienced rapid growth - exceeding 20% annually over the past two years - driven by higher utilization and increased provider rates. Although recent WellSense’s insourcing efforts and contract negotiations may help moderate this trend, utilization is expected to remain elevated.
    
    Pharmacy costs are also expected to remain at elevated, double-digit levels. This is primarily driven by increased use of high-cost brand and specialty medications, based on projections from our pharmacy benefit manager (PBM) and Milliman.While anti-obesity GLP-1 drugs are excluded, a certain portion of members are expected to transition to diabetes-indicated GLP-1 therapies, where clinically appropriate, resulting in continued utilization of these high-cost medications. At the same time, manufacturer rebates have declined due to factors such as biosimilar adoption, changes in federal pricing policies, and adjustments related to the 340B program.
    
    Risk Adjustment:
    
    Updates to the 2027 CMS HHS Risk Adjustment model - based on Wakely’s simulation using 2025 experience - indicate a meaningful decrease in WellSense’s relative risk score. Rapid membership growth since 2024 has also lowered average risk levels due to shifts in member demographics. In addition, WellSense’s relatively lower average premium compared to the merged market increases the impact of risk adjustment transfers.
    
    Contribution to Surplus:
    
    The 2026 approved rates included a minimal contribution to surplus of 0.1%, well below the allowable 1.9%. The proposed 2027 rates reflect a return to a 1.9% contribution to surplus, which is necessary to maintain financial stability and ensure the continued availability of affordable coverage options.
    
    Fallon Community Health Plan Inc.
    
    Key Drivers for the Proposed Rate Change
    
    The most significant drivers of the 25.7% rate change is summarized below:
    
    5.1% rate increase due to a decrease in risk adjustment transfer receivable
    
    8.5% increase to claims due to changes in base period allowed claims from 2024 to 2025 and impacts due to shifts in metal, age, and geography
    
    3.3% increase to claim costs because of anticipated morbidity changes due to federal and state policy, such as the expiration of enhanced premium subsidies
    
    2.4% for utilization and mix trends
    
    3.7% for unit cost trends
    
    -0.7% reduction due to lower contribution to surplus
    
    1.5% increase due to changes in taxes and fees such as the Exchange User Fee, PCORI, and MA State Assessment
    
    Harvard Pilgrim Health Care, Inc.
    
    KEY DRIVERS FOR THE PROPOSED RATE CHANGE
    
    See accompanying file called “Exhibit for Public Release” for additional detail.
    
    Medical Trend: A key driver of health insurance premium increases year-over-year is medical trend, which is comprised of inpatient, outpatient, and physician services. Medical trend includes both increases in the cost of the services provided by hospitals and physician groups and increases in the utilization and severity of these services by our members.
    
    For 2026 and 2027, Harvard Pilgrim expects there to be continued upward pressure on medical cost increases, driven by the higher inflationary environment and labor shortages that have led to providers requesting higher rates of reimbursement. While Harvard Pilgrim expects to successfully partner with hospitals and physicians across the state to moderate these cost increases, and continue to make quality care accessible for all, the increases are expected to be above historical levels.
    
    Harvard Pilgrim also continues to experience elevated medical utilization & severity trends. Utilization has increased across multiple categories of services and is not driven by any single event or service type.
    
    Pharmacy Trend: Pharmacy spend continues to put significant upward pressure on overall claim trend, particularly for brand drugs such as Immunomodulators, oncology drugs and other high-cost specialty drugs, and this is expected to continue in 2027. Note that as of January 2026, Harvard Pilgrim no longer covers GLP1 for weight loss indications; the reduction in expected future claim costs for this change in coverage is reflected in the filed rates.
    
    Risk Adjustment: Both actual and projected changes in the risk of Harvard Pilgrim members, relative to the market, results in a higher expected receivable for Harvard 1Pilgrim. This is helping moderate the increase, partially offsetting the medical and pharmacy trends.
    
    Other drivers of the rate change include a provision for the anticipated impact of the revised PACT Act and recently finalized prior authorization regulations, updated administrative cost assumptions, and the impact from the updated base period experience.
    
    Health New England, Inc
    
    KEY DRIVERS FOR THE PROPOSED RATE CHANGE
    
    Health insurance premiums reflect the cost and usage of medical care and services. Health New England (HNE) has been impacted by increases in these areas due to higher costs and utilization of medical services and prescription drugs. As a result, our medical and pharmacy trends continue to rise.
    
    The largest driver of HNE’s 2026 requested rate increase is a rise in the costs of medical services and drugs. Pharmacy costs are expected to increase by 8.2% in 2027.
    
    This increase is driven by increased use of specialty drugs and the growth of new therapies. Members are also expected to use 3.4% more prescription drugs in 2027.
    
    Physicians and hospitals are facing economic pressures caused by supply chain shortages, overall inflation and continued workforce challenges. As a result, providers are seeking higher reimbursement for their services. HNE continues to be diligent but is routinely required to increase service reimbursement rates at levels that exceed the 3.6% cost control benchmark, established by the MA Health Policy Commission, to maintain its current provider network.
    
    Mass General Brigham Health Plan, Inc.
    
    KEY DRIVERS FOR THE PROPOSED RATE CHANGE
    
    ...Several key factors are driving the proposed rate increase:
    
    Policy and Market Changes Impacting Affordability and Risk Pool
    
    The implementation of the federal law H.R. 1 also known as the One Big Beautiful Bill Act is driving significant shifts in how individuals and families qualify for coverage and what they pay for their health plans. Further, the expiration of enhanced premium tax credits has affected affordability, reducing the financial support that previously made health insurance more accessible for our members. These federal policy changes negatively affect the risk pool, through the loss of lower-risk members and limit access to more affordable plan options, particularly for our Health Connector members.
    
    We are seeing a growth of self-insured “level funded” small group options, from 2 percent in 2021 to over 11 percent in 2025 (based on the Center for Health Information and Analysis (CHIA) Enrollment Trends Databook as of September 2025 ). These products are medically underwritten which pulls small groups with favorable risk out of the merged market risk pool, leading to a deterioration of the fully insured merged market risk pool and worsening affordability for individuals and small businesses who remain in the merged market.
    
    Rising Cost and Utilization of Healthcare Services
    
    Industry-wide increases in the cost and utilization of healthcare services continue to reflect both regional and national trends. Trends are being driven by rising incidence of chronic conditions, as well as new medical technologies and treatments, which are improving outcomes, but often come at high costs set by manufacturers. This filing incorporates efforts to improve the effectiveness and efficiency of utilization management and care management processes through investment in greater integration between plan and provider from both a technology and a payment perspective.
    
    Accelerated Pharmacy Trends
    
    Pharmacy costs remain a significant driver of trend, particularly due to increased utilization of specialty medications and the introduction of new, high-cost therapies. For some conditions, such as diabetes, per-patient spending, rather than price alone has increased, due to more intensive treatment and management with higher cost treatments. Despite discontinuing cov erage for GLP-1s for weight loss, we continue to see rising utilization for diabetic GLP-1s as these treatments increasingly are being used to treat diabetes and expanded for other conditions. MGBHP has accelerated the use of formulary and pipeline management strategies aimed at reducing pharmacy spend by evaluating areas such as alternatives to clinical duplicates, including movement to biologic equivalents for some specialty medications and adjusting preference away from high-cost brands and generics.
    
    Investments in Access and Member-Centered Care
    
    The rate filing incorporates strategic investments to improve access to high-quality, affordable care. These include a robust women’s health portfolio, expansive behavioral health and mental health solutions, virtual primary care services, and digital tools designed to enhance member engagement and care coordination. Overall, the proposed rate change reflects a balanced approach to managing these cost pressures while continuing to provide comprehensive, high-quality coverage. Mass General Brigham Health Plan remains focused on mitigating cost increases through targeted pharmacy and care management initiatives, operational efficiencies, and disciplined administrative cost management, while investing in programs and innovations that improve affordability, access, and member outcomes.
    
    Tufts Health Public Plans, Inc.
    
    KEY DRIVERS FOR THE PROPOSED RATE CHANGE
    
    • Medical Trend: A key driver of health insurance premium increases year-over-year is medical trend, which is comprised of inpatient, outpatient, and physician services. Medical trend includes both increases in the cost of the services provided by hospitals and physician groups and increases in the utilization and severity of these services by our members.
    
    For 2026 and 2027, THPP expects there to be continued upward pressure on medical cost increases, driven by the higher inflationary environment and labor shortages that have led to providers requesting higher rates of reimbursement. While THPP expects to successfully partner with hospitals and physicians across the state to moderate these cost increases, and continue to make quality care accessible for all, the increases are expected to be above historical levels.
    
    THPP also continues to experience elevated medical utilization & severity trends. Utilization has increased across multiple categories of services and is not driven by any single event or service type.
    
    Pharmacy Trend: Pharmacy spend continues to put significant upward pressure on overall claim trend, particularly for brand drugs such as Immunomodulators, oncology drugs and other high-cost specialty drugs, and this is expected to continue in 2027. Note that as of January 2026, THPP no longer covers GLP1 for weight loss indications; the reduction in expected future claim costs for this change in coverage is reflected in the filed rates.
    
    Risk Adjustment: Both actual and projected changes in the risk of THPP members, relative to the market, results in a higher expected payable for THPP, increasing the average rates. In particular, changes in member eligibility for state and/or Federal subsidies are expected to change the member mix and risk profile more negatively for THPP than the market.
    
    Other drivers of the rate change include a provision for the anticipated impact of the revised PACT Act and recently finalized prior authorization regulations, updated administrative cost assumptions, and the impact from the updated base period experience.
    
    UnitedHealthcare Insurance Company
    
    KEY DRIVERS FOR THE PROPOSED RATE CHANGE
    
    A rate change increase of 14.2% is necessary for 2027 renewals. This increase is necessary largely due to the following key drivers:
    
    Medical and pharmacy claim costs continue to increase, including but not limited to the following services which have seen significant increases:
    
    Outpatient Surgery
    
    Inpatient Surgery
    
    Infusion Services and Specialty Drug Costs
    
    Emergency Care Costs and over-utilization
    
    Mental Health/Behavioral Health Services
    
    Physician Office Visits
    
    Maternity Inpatient Services
    
    UHIC is required to pay payments into the ACA Risk Adjustment program. For 2025, we are projected to pay 2.2% of our premiums into the risk adjustment program, which reduces our 2027 rates by 3.6%.
    
    UHIC has faced increases to administrative expenses, driven by inflationary pressures.
    
    Historical rate levels have not fully kept pace with emerging experience, increasing the pressure on current rate proposals.
    
    UPDATE 9/4/26: The Massachusetts Division of Insurance has published the 10.6%, while small group plans dropped from 12.7% to 11.0%.
    
    Massachusetts
    2027 Rate Changes
    Thu, 09/03/2026 - 8:36am
    Yesterday I wrote about the standard monthly Medicaid/CHIP enrollment report published by the Centers for Medicare & Medicaid Services (CMS). I noted that as of April 2026, total combined Medicaid & CHIP enrollment had fallen by another 398,000 people, to around 73.9 million Americans.
    
    I also noted that this figure is nearly 5.1 million lower than it was as of January 2025...the same month that Donald Trump returned to the White House and Republicans took over all three branches of the federal government.
    
    However, this, combined with my obsession over the lack of any updates to the official "monthly" ACA exchange effectuated enrollment report since it was first published back in July, inspired me to take a closer look at just how many people have lost healthcare coverage total since the Trump 2.0 regime took power.
    
    However, as I warned over a year ago (shortly after the OBBBA was signed into law), over half the provisions of the Big Ugly Bill have already gone into effect...and the negative results are already devastating.
    
    As I noted in my post yesterday, Medicaid/CHIP enrollment dropping isn't necessarily a terrible thing...depending on the reason why their enrollment is terminated.
    
    If it's because their income increased to the point that they are no longer eligible and they shifted over to a subsidized ACA exchange plan, that's a good thing (of course they may not see it that way since Medicaid provides more comprehensive coverage at almost no cost to the enrollees).
    
    If it's because they got a new job which includes healthcare benefits, that's a good thing!
    
    If it's because they joined the military and are now covered by the VA or Tricare, again, that's a good thing!
    
    If it's because they turned 65 and moved from Medicaid to Medicare, that's...fine!
    
    And of course in some cases they may have died. I mean, that's not a good thing, but it happens.
    
    In order to figure out how many fewer people have comprehensive healthcare coverage now when Trump re-took office, there are five major enrollment numbers to look at: Employer-sponsored coverage, Medicare, Medicaid/CHIP, ACA coverage...and the total U.S. population (remember, population growth is a thing).
    
    First up: Medicaid/CHIP (the Children's Health Insurance Program), which are grouped together for purposes of official enrollment reports. As I noted yesterday, enrollment in Medicaid/CHIP across all 50 states + the District of Columbia (I'm not looking at Puerto Rico or the other U.S. territories in this analysis) dropped from around 79.4 million people in January 2025 to less than 74.4 million as of April 2026...a drop of over 5 million people.
    
    However, CMS has also published the preliminary Medicaid/CHIP enrollment report for May. I didn't use that report because the numbers often change a bit between the preliminary and final versions, but according to the preliminary data, Medicaid/CHIP enrollment had nearly 5.9 million people.
    
    Next: Medicare. This is the easiest category, because the official CMS monthly report is also fully updated through May 2026. In this case, enrollment increases pretty much every month for an obvious reason: Over 90% those enrolled in Medicare became eligible because they turned 65, which means except for very rare exceptions, they're generally enrolled in it until they die. The other ~10% are people under 65 who have According to the latest report from CMS, as of May, just under 70.5 million Americans were enrolled in Medicare, or just under 1.6 million more than were enrolled as of January 2025. This reduces the number who have lost coverage to around 4.3 million.
    
    Next: ACA individual market enrollment. Again, I was pleasantly surprised back in July when CMS revamped their ACA exchange effectuated enrollment database to bring it in line with the formats for Medicare and Medicaid/CHIP reports. The initial report included state-level effectuated enrollment data from all the way back in 2026 up through February 2026, which is very helpful!
    
    As of February 2026, effectuated ACA exchange enrollment had dropped from 22.2 million Americans nationally to less than 19.2 million...a net drop of over 3.0 million people, pushing total coverage losses back up to 7.3 million people.
    
    Unfortunately, as of this writing,
    
    Three states (NJ & AR, GA, NV, VT &
    
    NEXT, I use the estimated (or actual) enrollment numbers for March, April and May for each of these 17 states to extrapolate what the monthly enrollment changes might look like nationally:
    
    For instance, from February to March, I estimate that enrollment across these 17 states dropped by a further ~3.4%, which would translate to nearly 650,000 more people losing ACA enrollment nationally.
    
    From March to April, I put it at a further ~3.7% drop (although only 16 states are included since I only have Washington data through March), or another ~690,000 people.
    
    Finally, from April through May, I estimate that enrollment across the remaining 13 states only dropped by about 0.8%, or another ~140,000 people.
    
    All told, if this is accurate nationally, it means that ACA enrollment dropped by another ~1.5 MILLION people from February through May 2026.
    
    KEEP IN MIND, HOWEVER, that eight of the seventeen states that I'm basing this on, including the largest (California), also offer their own supplemental financial subsidies to enrollees!
    
    I can't overstate how critically important this is, since some of these states are very generous with those subsidies, especially New Mexico!
    
    New Mexico is backfilling 100% of lost federal tax credits for 100% of enrollees!
    
    California is covering 100% of lost tax credits for all enrollees earning up to 150% FPL
    
    Maryland is covering 100% of lost tax credits fro all enrollees up to 200% FPL and 50% for those earning up to 400% FPL
    
    Colorado is providing up to $80/mo to the first member of households earning up to 400% FPL and up to $29/mo per additional household member
    
    ...etc, etc. In short, ACA enrollees in these states have been harmed far less (or not at all, in the case of NM!) than most of the other states.
    
    In addition, states like Minnesota and New York have Basic Health Plan programs in place for enrollees earning between 138% - 200% FPL, which means their exchange enrollees have a very different financial skew than those in most states.
    
    The larger point is that overall, I'd expect the drop in enrollment across the remaining 34 states (which collectively comprised 2/3 of total ACA enrollment as of February) to be considerably higher since almost none of them include any sort of mitigating factor like state subsidies, BHP programs and so forth.
    
    To give you some idea of what I'm talking about, from January to February...
    
    Enrollment in these 17 states actually increased by 2.4%, from 6.35 million to 6.50 million
    
    Enrollment in the remaining 34 states dropped by 8.5%, from 13.84 million to 12.67 million
    
    So, how much higher could the actual national drop since February be? That's difficult to say, but I'd put my 1.5 million estimate above as a lower bound limit, with perhaps double that, or ~3.0 million, as a realistic upper bound limit as of May 2026.
    
    At this point, if you include Medicare, Medicaid, CHIP & ACA exchange enrollees, we're talking about a net drop ranging between ~8.8 million to ~10.3 million people.
    
    BUT WAIT, THERE'S MORE!
    
    This is where I'm bringing in population growth. For that I'm utilizing the net population growth of right around 1.5 million people.
    
    If you add this population to the mix, you get a grand total of between 10.27 million and 11.75 million more Americans not enrolled in a public healthcare coverage program as of May 2026 than in were as of January 2025. It's important to note that this isn't quite the same thing as counting how many lost coverage, but not having healthcare sucks regardless of how you slice it.
    
    OK, but what about employer-based coverage? A lot of that population growth comes from newborn babies whose parents have coverage through the company they work for, right? And again, some number of those who have lost Medicaid, CHIP or ACA coverage have presumably transferred over to employer-based coverage as well, right?
    
    Well...yes, except for one thing:
    
    , that was 7.5% in January 2025...and rose to 8.1% as of May 2026.
    
    In other words, no matter how you slice it, fewer people were employed overall nationally in May 2026 than as of January 2025.
    
    I'm not saying that there are fewer Americans with employer-based healthcare coverage than there were a year and a half ago, but I feel pretty confident that there aren't more people with ESI coverage either.
    
    What about the U.S. Military? This technically falls under "employer-based" coverage since your employer is, well, the U.S. Military, but according to the Defense Dept (no, I'm not gonna call it the War Dept), What about Federal Employees? Well, again, these fall under "employer-based" coverage as well...but it's a moot point anyway, since thanks to Elon Musk's DOGE Nazi Incel Brigade last year, How about State and Local Government Employees? Nope....which are, for the most part, pretty much junk.
    
    Keep in mind that this only brings things up through May of this year. While it's theoretically possible that Medicaid & ACA enrollment will see a miraculous turnaround for the rest of 2026, it certainly doesn't seem like that's very likely to happen...
    
    UPDATE: I almost forgot about the Basic Health Plan programs in New York, Minnesota, Oregon and the District of Columbia!
    
    New York: : +10,903
    
    Minnesota: : +6,768
    
    Oregon: potentially up to 25,000 enrolled today)
    
    So yes, it's conceivable that up to ~60,000 people have gained coverage via BHP programs since January 2025.
    
    Of course, since May, Republicans cutting the budget as part of the OBBBA...
    
    And remember, all of this is BEFORE the Medicaid work reporting requirements kick into effect in most states starting in January (three states----have actually already begun implementing the new work reporting requirements via waivers, but again, there's either no data or not enough data from those states yet to know what sort of negative impact it's having).
    
    It's also before the upcoming 15% average additional premium hikes for unsubsidized ACA enrollees and another , which will eliminate a significant chunk of the uncertainty in my estimates above.
    
    UPDATE 9/3/26 12:35pm: Well that figures. Shortly after I posted this, the
    CMS
    ACA
    Effectuated Enrollment
    Medicaid
    CHIP
    Medicare
    Effectuation Report
    U.S. Census Bureau
    Population Growth
    Tue, 09/01/2026 - 5:34pm
    The Trump Regime has dropped about 0.5% from March 2026, or another ~398,000 people.
    
    The all-time high enrollment watermark for Medicaid/CHIP was in (referenced above) and the June 2025) while the Trend Snapshot is only 4 months out of date (through March 2026).
    
    The MBES count includes individuals enrolled in limited benefit plans and the Performance Indicator count does not include such individuals.
    
    The MBES data represents the count of unduplicated individuals enrolled in the state’s Medicaid program at any time during each month in the quarterly reporting period, while the Performance Indicator data captures the count of individuals enrolled on the last day of the month.
    
    The MBES count only includes individuals whose coverage is funded through Medicaid (title XIX of the Social Security Act), while the published Performance Indicator also includes individuals funded through CHIP (title XXI of the SSA).
    
    MBES and Performance Indicator data may be derived from different state systems.
    
    Retroactive state adjustments to MBES or Performance Indicator data may be in progress.
    
    States have likely generated MBES data and Performance Indicator data from state systems on different dates.
    
    The other major difference: The MBES reports include Medicaid enrollees in the U.S. territories: American Samoa, Guam, N. Mariana Islands, Puerto Rico and the U.S. Virgin Islands.
    
    The MBES numbers for U.S. territories stood at 1.44 million Medicaid enrollees as of June 2025. If you add those to the Trend Snapshot total for the 50 states +DC, it comes in at 75.8 million as of April 2026.
    
    It's also worth noting that ACA Medicaid Expansion enrollment specifically was 20.4 million as of June 2025 according to the MBES report, down around 3.6 million from the all-time high it reached in May 2023.
    
    Between January 2025 (when Trump took office again) and April 2026, net Medicaid/CHIP enrollment has dropped by nearly 5.1 million, or 6.4%.
    
    This ranges from virtually no net enrollment change at all in North Carolina to as much as a 20.4% drop in Medicaid/CHIP enrollment in Indiana, where there are 365,000 fewer Hoosiers enrolled in either program than at the beginning of Trump 2.0.
    
    In terms of raw numbers, the largest decline in enrollment is California, as you'd expect, where over 1.5 MILLION residents have been removed from the Medicaid/CHIP rolls since January 2025 (an 11.5% drop).
    
    Of course, Medicaid/CHIP enrollment dropping isn't necessarily a bad thing if the reason is because those folks instead moved to other types of comprehensive healthcare coverage instead such as individual coverage (ACA marketplace), Medicare or employer-sponsored coverage. However, given what's happening with the ACA marketplace this year and that 200,000 more Americans were unemployed in , that's not terribly comforting.
    
    Medicare enrollment, on the other hand, has gone up by over 1.6 million since January 2025, which does cancel out some of the Medicaid/CHIP losses...except that most of those additional Medicare enrollees didn't shift from Medicaid/CHIP. Most of them aged out from employer coverage, while some turned 65 and transitioned from ACA policies or other types of healthcare coverage.
    
    CMS
    Medicare
    Medicaid
    CHIP