Opinion: The 2027 Obamacare sign-up pitch is accurate, and still misleading

Open enrollment for 2027 Affordable Care Act marketplace coverage opened on November 1, and the Centers for Medicare & Medicaid Services marked the moment with an upbeat fact sheet on 2027 plans and prices. The agency says more than 75 percent of HealthCare.gov shoppers will keep access to premiums at or below $50 a month, that subsidized enrollees will have a plan where the federal government covers nearly 90 percent of the lowest-cost premium, and that the average shopper can now choose among 35 health-savings-account-eligible plans, which CMS calls a more than 1,000 percent increase in HSA options. Every one of those claims appears to be accurate as stated. None of them is the number that determines whether a family can actually afford coverage next year, and the document does not include that number at all.

The sales pitch versus the sticker price

The figure CMS left out is the one insurers themselves have been filing with regulators all year. A KFF analysis of 2027 rate filings from 276 insurers across all 50 states and the District of Columbia found a median proposed premium increase of 15 percent, on top of an 18 percent median increase the year before. That is the second straight year of double-digit marketplace premium growth, and KFF's separate review of enrollee-level data pegs the rise in benchmark silver-plan premiums at roughly 13 percent nationwide for 2027. Rising medical costs are still the single biggest driver, as they are every year, but insurers told regulators that the end of enhanced subsidies and a sicker remaining risk pool are adding several additional percentage points on top of that.

CMS's $50-a-month figure is not wrong; it is simply describing a different product than the one most people picture when they hear health coverage. The plans available at that price point are overwhelmingly bronze and catastrophic-tier plans, which trade a low premium for a much higher deductible. Pointing to broader access to those plans, and to a larger menu of HSA-eligible options, as evidence of affordability sidesteps the question of whether anyone at median income can actually use that coverage without facing thousands of dollars in costs before it pays for anything.

• 15% — KFF's median proposed 2027 premium increase across 276 insurers
• 1.2 million — drop in marketplace plan selections during the 2026 open enrollment period versus 2025, per KFF
• 760,000 — people whose marketplace enrollments CMS canceled in September, citing fraud
• Dec. 31, 2025 — the date enhanced premium tax credits lapsed, with no extension enacted since

Why the credits lapsed, and why that matters now

None of this happened in a vacuum. The enhanced premium tax credits that lowered marketplace premiums for roughly 22 million enrollees expired at the end of 2025 after Congress failed to act. The Senate rejected both a Democratic three-year extension and a competing Republican proposal built around health savings accounts in votes on December 11, 2025, with the Democratic bill falling short of the 60-vote threshold despite four Republican votes in favor. The House later passed its own three-year extension in January, 230-196, with 17 Republicans joining Democrats, but that bill has sat in the Senate since, with bipartisan talks on a shorter compromise reported stalled.

The Congressional Budget Office's own modeling, released through a Senate Finance Committee release of CBO's findings, estimated that letting the credits lapse would leave about 2.2 million more people uninsured in 2026 and 3.7 million more by 2027, with gross benchmark premiums roughly 4.3 percent higher in 2026 from the credit expiration alone, separate from any underlying medical-cost growth. That is a projection, not a verified outcome, but it lines up with what KFF is now finding in real enrollment data: plan selections during the 2026 open enrollment period fell by 1.2 million from the year before, and effectuated enrollment, measured after people actually paid their first premium, fell roughly 12 percent, from 21.8 million to 19.2 million.

A fraud crackdown that cuts both ways

The administration has its own explanation for the shrinking enrollment numbers, and it is a different one than expiring subsidies: fraud. In a September 22 press release, CMS announced it was canceling roughly 315,000 enrollments covering more than 760,000 people on the federal marketplace, citing improper or unauthorized sign-ups, and projected about $2.2 billion in savings from the move. The agency also flagged another 419,000 enrollees for additional identity and income verification and imposed a moratorium on new marketplace brokers running through February 1, 2027.

Americans using HealthCare.gov will have robust access to low-cost plans.

That line, from the October fact sheet, sits awkwardly next to what happened to some of the very enrollees CMS said it had purged for fraud. By mid-October, KFF Health News reported that the administration had quietly reinstated some of the people it had dropped, and that not all 760,000 disenrollments fit the phantom-enrollee description officials used to justify the crackdown. If a meaningful share of those people were legitimately enrolled, then the anti-fraud campaign is not just trimming waste; it is also mechanically shrinking the enrollment numbers the administration separately points to as evidence that its affordability message is working.

Who actually bears this, and what comes next

The people most exposed are the roughly 22 million Americans who buy coverage on the individual marketplace rather than through an employer: early retirees not yet eligible for Medicare, gig and contract workers, small-business owners, and anyone whose income sits just above the subsidy cliffs that reappeared once the enhanced credits expired. For them, a 15 percent median rate increase is not an abstraction in a regulatory filing; it is a monthly bill that either gets paid or doesn't, and KFF's enrollment data suggests a growing number of people are choosing not to pay it, or are being priced out before they get the chance.

Open enrollment runs through January 15, and nothing currently before Congress would change the subsidy picture before most people have to decide whether to re-enroll. The honest version of the 2027 pitch would say plainly that premiums are up for a second straight year, that the credits which blunted those increases for five years are gone, and that the plans being advertised as low-cost are, for many families, a downgrade rather than a bargain. CMS is entitled to highlight what has genuinely improved, including a wider menu of HSA-eligible plans. It is not entitled to let that menu stand in for an affordability record the agency's own numbers do not support.