Insurers want 15% more for ACA plans. Black Americans were already 1.5 times as likely to be uninsured.

Open enrollment for 2027 Affordable Care Act coverage began Sunday, and insurers are asking for a median premium increase of 15%, the second straight year of double-digit hikes, according to KFF analyst Matt McGough. For Black Americans, who were already more likely to be uninsured than white Americans, the price of staying covered keeps climbing.

In 2024, 10.1% of Black people under 65 had no health insurance, compared with 6.8% of white people the same age. KFF found Black people were 1.5 times as likely to be uninsured in every year from 2010 to 2024, and the rate rose in 2024 as pandemic-era Medicaid protections ended. That was before this year’s marketplace changes.

Congress let the enhanced premium tax credits expire at the end of 2025. KFF reports that the number of people enrolled and paying for marketplace plans fell from a record 21.8 million in 2025 to 19.2 million in 2026, the first decline in seven years. To keep the same coverage, enrollees faced premium payments 114% higher on average, more than $1,000 a year. Actual payments rose 58% on average because people moved to cheaper plans, and that came with a cost: deductibles rose 37%, about $1,000 more per person.

Eight in ten enrollees said their health care costs went up. In a KFF survey, 17% of returning enrollees said they were not confident they could afford their premiums for all of 2026.

KFF’s published analysis of the 2026 decline carries no breakdown by race, so how many Black enrollees dropped out is not yet known. The increases apply to everyone who buys a marketplace plan, which is where many people without job-based coverage turn.

The 2027 shopping season brings more changes. Six insurers are entering the marketplace and 11 are leaving, so some enrollees will have to pick a new plan even if they want to keep their old one. Adults aged 50 to 64, about a third of enrollees, can face premiums up to three times those of younger adults without subsidies, per KFF. AARP advises caution with low-premium bronze plans, whose deductibles averaged $7,500 in 2026.

The deadline to enroll for coverage starting Jan. 1 is Dec. 15. In many states, enrollment stays open until Jan. 15 for coverage starting Feb. 1. Midterm voters will cast ballots Tuesday with those prices in front of them.