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Did health insurers raise premiums after Biden's 2021/2022 ACA policy changes?
Executive Summary
Health insurers did not uniformly raise premiums in direct response to President Biden’s 2021–2022 ACA changes; instead, insurer pricing moved under multiple pressures—expanded subsidies cut out-of-pocket costs for many enrollees while insurers proposed or filed higher rates later as medical costs and policy uncertainty rose. Analyses show modest benchmark premium growth in earlier years after the American Rescue Plan, but by 2025–2026 insurers were proposing substantially larger rate increases tied to rising health-care costs and the possible expiration of enhanced premium tax credits, making the net effect on consumer payments highly dependent on whether subsidies continued [1] [2] [3].
1. Why the question matters: subsidies reshaped who pays and what “premiums” mean
The 2021 American Rescue Plan expanded premium tax credits and made coverage cheaper for millions, producing clear declines in what enrollees paid at point of sale even if list premiums changed; KFF estimated significant monthly savings for many and widespread access to near-zero-dollar plans, making the policy effect on consumer costs immediate and significant [1]. That same expansion altered the composition of Marketplace risk pools because 22–25 million enrollees received subsidies by 2025–2026, so changes in subsidy policy or enrollment mix can amplify or mute insurer rate reactions. Analysts caution that focusing solely on insurer-filed or benchmark premium percentages misses the key consumer-facing metric: after-tax-credit premiums that many people actually pay [4] [5].
2. What happened to list and benchmark premiums after 2021–2022: modest early rises, larger proposals later
Contemporary assessments find benchmarks and average premiums rose modestly in the early post-ARP years—a national average benchmark increase near the low single digits was reported for 2023–2025—reflecting inflation, utilization, and drug costs rather than an insurer windfall driven by the ARP itself [2] [5]. By mid- to late-2025, however, insurer filings for 2026 showed median proposed increases in the mid-to-high teens (15–18%) and some estimates put 2026 proposals around 26% on average, with insurers pointing to rising medical costs and the looming expiration of enhanced credits as drivers [3] [6] [7]. Those proposals are subject to regulatory review and revision, and do not automatically equate to final approved rates.
3. Did insurers “raise premiums because of” Biden’s policy changes? The evidence is mixed and causal links are weak
Direct causal attribution that insurers raised premiums in reaction to Biden-era subsidy expansions is not supported as a simple one-to-one relationship. The ARP and later 2022 adjustments reduced consumer premiums through tax credits and increased enrollment, and several sources document that premiums paid by enrollees fell after subsidies rose [8] [1]. Insurers’ later rate requests cite general medical inflation, labor costs, specialty drug prices, and uncertainty over subsidy expirations—not that the subsidies themselves caused rate hikes [3] [7]. Economists and regulators note that policy changes altered incentives and enrollment composition, which can influence pricing, but the data show multiple concurrent drivers rather than a single policy trigger [5].
4. The big conditionality: expiry of enhanced tax credits would sharply change consumer outcomes
Multiple analyses converge on a stark conditionality: if the enhanced premium tax credits expire at the end of 2025, many subsidized enrollees would face double-digit or much larger increases in what they pay, with some estimates projecting average out-of-pocket premium payments more than doubling in 2026 and tens of millions facing higher bills or dropping coverage [4] [6] [7]. Insurer filings for 2026 incorporate assumptions about subscriber churn and a sicker, less subsidized risk pool if subsidies lapse—factors that push insurers to seek larger rate increases. Thus future consumer costs hinge more on congressional or administrative action on subsidies than on historical ARP enactment alone.
5. Bottom line: nuanced reality — subsidies reduced consumer premiums initially; later insurer filings reflect other pressures and subsidy uncertainty
The record shows the American Rescue Plan and related 2021–2022 actions lowered premiums for many enrollees, while insurer behavior in subsequent years reflects medical inflation, drug costs, market competition, and the political uncertainty about subsidy continuance [1] [2] [3]. Claims that insurers broadly raised premiums “because of” Biden’s ACA changes oversimplify a complex interplay: subsidies reduced what people paid even as insurers later sought higher list rates responding to standard cost pressures and the risk that subsidies would end, which would sharply increase consumer payments absent legislative action [6] [5].