For 2027, ACA Marketplace insurers in 16 states and DC propose a median premium increase of 14%, marking the second consecutive year of double-digit hikes and a 33% rise over two years. Key drivers include rising healthcare costs, inflation, labor shortages, increased claims severity, and the expiration of enhanced premium tax credits, which reduced enrollment and worsened risk pools. Other factors include federal regulatory changes, provider consolidation, and costly medications like GLP-1s.