Were premiums for healthy individuals raised after the ACA, as they now had to cross subsidize more unhealthy people in insurance? If they were raised, by how much? Anything significant?
Executive summary
Yes — available reporting shows that marketplace premiums and what healthy individuals pay rose after enhanced ACA subsidies were enacted and will rise again if those enhancements expire; insurers and analysts attribute much of the 2026 rate pressure to the expected loss of healthier enrollees and to insurers’ rate filings assuming subsidy expiration (insurers forecast about a 4 percentage-point direct rate effect; KFF projects average out‑of‑pocket premium payments would rise ~114% for subsidized enrollees if enhancements expire) [1] [2] [3].
1. How cross-subsidies and risk mix matter — insurers’ view
Insurers say when subsidies are generous more lower‑cost, younger, or relatively healthy people join the marketplaces, which lowers average costs; if those subsidies lapse, insurers expect healthier people to leave and the remaining risk pool to worsen, prompting them to boost rates now to reflect that anticipated deterioration. State filings and insurer comments explicitly cite a worsening “average morbidity” and anticipate rate increases tied to the expected exit of healthier enrollees [1] [4].
2. Measured magnitudes in recent reporting
Analysts give different but consistent signals on magnitude. Peterson‑KFF found insurers’ filings implied the subsidy expiration drove rates an average of about 4 percentage points higher than they otherwise would be for 2026 [1]. KFF’s modeling shows that, on average, out‑of‑pocket premium payments for subsidized enrollees would increase roughly 114% (about $1,016 a year) if enhanced credits expire — a figure that reflects the combined effect of higher underlying premiums and much smaller government help to pay them [2] [3].
3. Recent headlines: big headline increases and context
Public filings for 2026 showed large nominal increases before accounting for subsidies: some aggregated reports put marketplace premium rate changes averaging in the mid‑20% range (AJMC reported a 26% average increase in submitted premiums) — insurers and analysts stress these are pre‑subsidy, pre‑finalization numbers and vary widely by state and marketplace [5]. Journalists and researchers emphasize that the headline percent changes translate into wildly different consumer outcomes depending on whether subsidies remain [5] [3].
4. Who notices the pain: subsidy recipients vs. unsubsidized healthy people
Most marketplace enrollees receive subsidies (CMS and KFF reporting put the share above 85–90%), so the enhanced subsidies primarily lowered what subsidized, often lower‑ and middle‑income people paid and drew more younger/healthier people into the pool [6] [3]. If subsidies lapse, those subsidized enrollees face large out‑of‑pocket jumps (KFF’s 114% average figure), while truly unsubsidized, higher‑income healthy people could also see higher full premiums but are a smaller share of the market; sources note the distributional effects matter [3] [6].
5. Why the 4 percentage‑point insurer estimate and the much larger consumer impact differ
Peterson‑KFF’s ~4 percentage‑point estimate describes insurers’ rate assumptions — the direct change to premiums they file statewide — driven by expectations about who will remain insured [1]. KFF’s 114% figure measures what subsidized consumers would pay out of pocket if the subsidy formula shrinks back to pre‑ARP levels; that outcome multiplies consumer cost exposure because the government share falls even as insurers may also raise underlying rates [1] [2] [3].
6. Political and policy context that colors the numbers
All sources emphasize these price signals are tied tightly to politics: the enhanced premium tax credits introduced in 2021 and extended through 2025 by later law are scheduled to expire unless Congress acts, and many insurers assumed expiry when filing 2026 rates [3] [1] [7]. Policy options under discussion — from temporary extension to means‑tested caps — would change both underlying premiums and consumer out‑of‑pocket outcomes; coverage and political incentives therefore shape insurer behavior now [8] [9].
7. Limitations, disagreements, and what reporters flag
Sources disagree on scale and emphasis: insurer filings emphasize a modest average direct rate effect (~4 points) while consumer‑facing analyses highlight much larger increases in what many people would actually pay without subsidies (114% average rise in KFF’s scenario) [1] [2]. Filings vary by state, insurer, and plan; final rates and consumer costs will depend on whether Congress extends enhanced credits or enacts alternative measures — a point the Health System Tracker, KFF, Brookings, and others stress [1] [3] [10].
8. Bottom line for a healthy individual wondering “was I made to cross‑subsidize sicker people?”
Available sources show the ACA’s subsidy structure and the 2021 enhancements shifted who could afford marketplace coverage and thus changed the marketplace risk mix; insurers say that change reduced average premiums while the potential removal of enhancements is driving filings that increase rates because insurers expect healthier people will leave [1] [4]. How much any particular healthy individual’s premium rose because of cross‑subsidization depends on timing, state, insurer, plan, and whether federal subsidies remain; national summaries point to insurer‑filed rate effects of about +4 percentage points and projected consumer out‑of‑pocket shocks (if enhancements expire) averaging roughly +114% for subsidized enrollees [1] [2].
Sources used: Peterson‑KFF Health System Tracker [1], KFF [3] [2], AJMC [5], Brookings [10], Bipartisan Policy Center [4], CBPP/other trackers [7] and related reporting cited above.