If you are one of the 617,000 people in Missouri or Kansas buying Obamacare insurance on healthcare.gov, expect sticker shock when next year’s premiums are announced.
With few exceptions, insurance companies selling health coverage through the Affordable Care Act marketplace plan to increase rates in 2026. In the Kansas City area, all but one carrier have asked Kansas and Missouri regulators for the right to bump up premiums — in one case by 40%.
The story is similar across the country.
A survey of proposed rates by KFF and the Peterson Center on Healthcare found a median planned increase of 18% among the 312 insurers participating in ACA marketplaces nationwide. That is 11 percentage points higher than last year and the steepest increase request since 2018. Only four insurers nationwide said they would decrease rates.
Insurance companies cited inflation, labor costs and expensive specialty drugs like GLP-1 weight loss medications. But health policy experts said much of the blame should fall on new Trump administration laws and policies that will increase the cost of coverage, drive healthy people to drop out and leave behind patients who cost the most.
Expiring tax credits and new rules
The first policy pushing up prices is that enhanced tax credits are set to expire.
Since 2021, those credits have offset the cost of health plans for more than 90% of marketplace enrollees and helped double enrollment. They expire at the end of the year if Congress doesn’t renew them.
The second policy is a new Centers for Medicare and Medicaid Services rule that overhauls how the marketplace operates.
Some changes shorten the enrollment period, eliminate automatic reenrollment and add stricter eligibility checks. Other changes alter how payments are formulated, which could raise premiums and force people to pay more for deductibles and copays.
“The bottom line is that out-of-pocket premiums will go up,” said Gideon Lukens of the Center on Budget and Policy Priorities. “People will pay higher deductibles and copays… And then a lot of people lose coverage as a result.”
Comparable to repealing Obamacare
The ACA marketplace reached more than 24 million enrollees nationally in 2025, including 417,000 in Missouri and 200,050 in Kansas — double 2021 levels.
But those highs are expected to plummet next year as premiums rise. The Kansas Health Institute predicted enrollment could return to 2021 levels and uninsured rates could “greatly increase.”
Next year’s increases come as the Congressional Budget Office projects Trump administration policies will reduce resources for the poorest households between 2026 and 2034. The CBO said poor households will lose an average of $1,200 annually, while top-income households can expect to gain $13,600.
“It’s not a repeal of the ACA, but the size of the impact is comparable,” Lukens said. “The way it’s done is more of a death-by-a-thousand-cuts way. … But the overall impact … will be to increase the number of people without coverage by getting close to where we were before the ACA.”
A vicious cycle
Once the dust settles, an estimated 8 million people are expected to lose coverage through the ACA marketplace. Another 9 million could lose Medicaid under federal legislation passed in July, which cuts federal spending by close to $1 trillion and adds new requirements.
“The worst case scenario here is bad,” said Caitlin Donovan of the Patient Advocate Foundation.
When people lose coverage, they’re less likely to seek care and more likely to get sicker before getting help, which strains hospitals and pushes rates higher.
“There is going to be a sicker population that’s in a much worse situation,” Donovan said.
When young and healthy people drop coverage, leaving behind those who are more expensive to cover, premiums spiral, said Christopher Garmon, assistant professor at the University of Missouri-Kansas City.
“Anything that makes healthy people less likely to enroll is going to increase costs and cause premiums to go up… And that is a vicious cycle,” he said.
The Commonwealth Fund estimates that people in Missouri who receive tax credits will see a $720 jump in annual premiums, while those in Kansas will see a $590 increase.
Rising premiums in Kansas and Missouri
Most insurers in the two states have requested increases.
Medica Insurance Co. said its rates need to go up 29.3% in Kansas and 29.2% in Missouri, while Celtic Insurance Co. proposed a 24.4% hike in Missouri.
Other carriers proposing increases include Oscar Insurance Co., which is asking for a 14.4% jump in Kansas and 11.7% in Missouri, and United Healthcare, which wants a 10.1% bump in Kansas and 10.7% in Missouri.
Blue Cross and Blue Shield of Kansas City is the only carrier in the market — and one of just four in the country — planning to lower rates, dropping 6.1% in Kansas and 4.4% in Missouri.
Less help available
Proposed rates must be approved by state regulators before being listed in the marketplace. That should happen this fall in time for open enrollment, which begins Nov. 1. This year, people have until Jan. 15 to enroll. Next year that window shortens to Nov. 1 through Dec. 15.
Many may not realize how much the ACA is changing. Earlier this year the Trump administration cut funding for navigators who help people find coverage and also slashed money for public information campaigns.
Justin Gust of El Centro Inc. said he’s seen this before: “There was a huge reduction in people enrolling.”
This article originally appeared here.