American healthcare, the priciest healthcare system in the world, is set to get even more expensive In the coming weeks, the roughly 160 million Americans who get health insurance through work will log into their benefits portals and pick a plan for 2027. Even for people used to rising healthcare costs, what they see may come as a shock. Employer health plan costs are projected to rise 8 to 10% next year, the largest increase in more than 20 years and double the average increase of the 2010s.
This spike is just the second in a series of three successive shocks to healthcare costs and coverage. The first came in January 2026, when the 24.3 million ACA Marketplace enrollees saw their after-subsidy premiums rise by an average of 114%. The second is the sharp increase in premiums and out-of-pocket costs for those who get insurance at work, the third year in a row of elevated increases.
The third comes next January, when Medicaid work-reporting requirements take effect, which CBO projects will eventually push nearly 6 million people out of coverage. History suggests that the American political system makes a bold attempt to reform healthcare about once a generation. President Harry Truman fought for national health insurance in 1945.
Johnson signed Medicare and Medicaid into law in 1965. President Bill Clinton pushed for reform in 1994. And President Barack Obama passed the Affordable Care Act in 2010.
With healthcare costs already among voters' top concerns, these shocks may create the next generational window for reform. In the meantime, here’s how the looming healthcare hike will impact insurance costs, wherever you get your coverage. The enhanced premium tax credits were first passed in the 2021 American Rescue Plan Act pandemic relief bill, then extended in the 2022 Inflation Reduction Act.
They expired on December 31, 2025, after Congress declined to renew them in the One Big Beautiful Bill Act (OBBBA). KFF estimates this decision raised after-subsidy premiums by 114%, or about $1,000 a year. In response, some people left the market and enrollment fell 12%, from 21.8 million to 19.2 million.
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