New ACA Plans Could Increase Family Deductibles to $31,000

Summary

Proposed 2027 A.C.A. rules would add cheaper catastrophic and some no-network options with much higher deductibles — more than $15,000 for individuals and $31,000 for families — shifting more upfront costs to patients. Supporters say the changes expand choice and reduce premiums, while critics warn they will erode essential benefits and protections, limit provider access, and make care unaffordable, especially for people with chronic conditions. The administration estimates up to two million fewer people could be covered in 2027, and new plans could reset subsidy benchmarks, raising costs for those seeking traditional networks. The clash reflects a broader divide between consumer-driven, high-deductible coverage and efforts to preserve affordability and comprehensive benefits.

Dr. Mehmet Oz, who oversees Medicare and Medicaid, promoted new proposals that he said would lower costs. Critics fear the options will increase medical bills and drive people out of insurance plans. Credit…Eric Lee/The New York Times Reed Abelson

Reed Abelson has covered the Affordable Care Act since its passage in 2010.

Published Feb. 26, 2026 Updated Feb. 27, 2026, 11:48 a.m. ET

Overview of the 2027 Proposed Rules

The Trump administration’s proposed new rules for Obamacare plans next year would shift more health care costs to Americans. The rules would permit much higher deductibles, potentially leading to larger medical bills. While the plans could offer substantially lower monthly premiums, they would leave enrollees exposed to thousands of dollars in medical expenses before coverage begins.

Political Context and Administration’s Rationale

The proposals come ahead of the midterm elections and are among the few steps the administration can take to lower premiums without congressional approval.
In his State of the Union address, Mr. Trump blamed “the crushing costs of health care” on the A.C.A., arguing that payments should go directly to Americans so they can “buy their own health care, which will be better health care at a much lower cost.” Major changes would require congressional action.
Joel White, a Republican health policy adviser, said the administration “did what it could within the confines of the statute to increase consumers’ choice, try to keep premiums low.”
Dr. Mehmet Oz, administrator for the Centers for Medicare and Medicaid Services, promoted the proposal: “The goal is simple: lower costs, more choice, and exchanges that work as intended.” The agency declined further comment.

Enrollment Trends and Affordability Pressures

More than a million people have dropped out of Obamacare this year to date, a decline many attribute to the lapse of enhanced subsidies at the end of last year.
Millions saw monthly premiums rise by double or more compared with last year.

Deductibles and Plan Designs

One type of plan under the proposal could raise the annual deductible to more than $15,000 for an individual and $31,000 for a family — far above current A.C.A. plans.
The individual deductible would be eight times the average for someone with job-based insurance.
Harvard economist Amitabh Chandra questioned demand for these products: “It’s going to be a really cheap product that nobody wants.”

Catastrophic or “Skinny” Plans: How They Work and Who They Fit

The proposal involves catastrophic or “skinny” policies.
These may suit younger, healthier people, but an ER visit or hospital stay could trigger large bills.
People with chronic conditions could end up paying for much — if not all — of their care out of pocket.
Preventive services and up to three primary care visits per year would be covered before the deductible.
Catastrophic plans are generally unavailable for federal subsidies and have typically been limited to people under 30.
Historically, catastrophic plans have been unpopular because some bronze plans are not much more expensive.

Expert Perspectives on Affordability

Dr. Joseph R. Betancourt of the Commonwealth Fund: “There’s no doubt that we have an affordability crisis. As we move forward to shifting more of the burden to patients, there’s a chance to really exacerbate the crisis.”

Changes to Benefits and Enrollment Rules

The proposed rules include measures that could make enrollment harder for some.
They would redefine essential health benefits; adult dental care would no longer qualify as an essential benefit.
The administration estimates up to two million people could drop coverage in 2027.

Provider Access and “No-Network” Options

The proposal would allow plans that may severely restrict access to doctors and hospitals, including options without a dedicated network.
Insurers could sell multiyear policies and plans that do not offer an established provider network.
No-network plans would pay a fixed amount per service; patients pay any difference if providers charge more.
Consumers would have to find providers willing to accept the plan’s rates, increasing the risk of sizable bills.

Supporters’ Arguments for Consumer-Directed Care

Republicans argue high-deductible plans promote price shopping and discourage unnecessary care.
They criticize Obamacare as a handout to insurers and say consumers should choose their own doctors and hospitals.
Joel White endorsed network-free plans as “hugely pro-consumer,” noting potential administrative savings and lower premiums.

Consumer Protections and Access Concerns

Ellen Montz, a former A.C.A. regulator now at Manatt Health, cautioned that regulators must ensure people can access care under no-network plans.
Katie Keith of Georgetown University warned: “It is not going to work as insurance as most people understand it, and what most people are looking for.”

Potential Impact on Subsidy Benchmarks

Cheaper, less comprehensive plans could become the benchmark for local subsidies, reducing subsidy amounts.
Consumers seeking traditional network plans might face higher net premiums if benchmarks shift downward.

State Snapshot: California Enrollment Choices

In California, more than a third of enrollees selected bronze plans with the highest out-of-pocket costs eligible for subsidies, up from less than a fourth last year.

Public Comments and Personal Stories

Early public comments (about 50 so far) include a California resident’s account of his son with diabetes who relies on expensive specialist visits and treatments. He argued higher deductibles could prevent access to critical supplies and care, risking hospitalization or death, and urged restoring enhanced subsidies.

Images

An insurance agency in Miami last year. Millions of people who rely on Obamacare saw their monthly premiums increase by double or more this year after the Republican-controlled Congress allowed enhanced subsidies to expire. Credit…Joe Raedle/Getty Images

Industry Case Study: Sidecar Health

Sidecar Health, an Ohio-based insurer, had to stop offering A.C.A. no-network plans at the end of 2023 when the government banned such policies.
Dr. Marty Makary, the FDA commissioner, is a former adviser to the company.
Sidecar CEO Patrick Quigley said the company’s premise is to have consumers treat health care dollars as their own; he declined to disclose customer counts.

Additional Critical Perspectives

Katherine Hempstead of the Robert Wood Johnson Foundation: “We’re normalizing hardship, and we’re normalizing catastrophe.” She said the rule “is not trying to make something comparable to employer coverage.”

Contributor and Corrections

Margot Sanger-Katz contributed reporting.
Correction (Feb. 27, 2026): An earlier version misstated the status of Sidecar Health’s A.C.A. offerings and its headquarters. The company has not offered A.C.A. plans with no network since 2023 and stopped taking part in the Affordable Care marketplaces. It is based in Ohio, not California.

About the Author and Publication

Reed Abelson covers the business of health care, focusing on how financial incentives affect the delivery of care, from consumer costs to provider profits.
A version of this article appears in print on Section A, Page 19 of the New York edition with the headline: Families Could Pay $31,000 Under G.O.P. Obamacare Plan. Order Reprints | Today’s Paper | Subscribe

Q&A

Question: What are the main changes the administration is proposing for 2027 A.C.A. plans? Short answer: The proposal would allow much higher-deductible “catastrophic” or “skinny” plans—over $15,000 for an individual and $31,000 for a family—along with options that may have no provider network and even multiyear policies. It would also tighten some enrollment processes and narrow required benefits, notably by removing adult dental care from the list of essential benefits. Supporters frame this as increasing choice and lowering premiums; critics say it weakens protections and makes coverage less usable.
Question: How would these plans lower premiums but raise people’s costs? Short answer: Monthly premiums could be substantially lower, but patients would have to pay far more out of pocket before insurance pays—potentially tens of thousands of dollars. While preventive services and up to three primary care visits would still be covered before the deductible on catastrophic plans, most other care would not be. Catastrophic plans also can’t be purchased with federal subsidies, limiting affordability for many.
Question: Who might benefit from these options, and who could be hurt? Short answer: Young, healthy people who rarely use care might prefer lower-premium plans and accept higher risk. People with chronic conditions or anyone facing an unexpected ER visit or hospital stay could see unaffordable bills, sometimes paying for much—or all—of their care out of pocket. Experts warn this could exacerbate an existing affordability crisis and deter people from seeking needed care.
Question: Will the proposals affect subsidies and overall coverage? Short answer: Yes. The administration estimates up to two million fewer people could be covered in 2027. Cheaper, less comprehensive plans could become the local subsidy benchmark, which would reduce subsidy amounts and make traditional network plans cost more for consumers who want them. Separately, the lapse of enhanced subsidies already contributed to over a million people dropping A.C.A. coverage this year.
Question: What are “no-network” plans and what risks do they pose? Short answer: These plans don’t contract with specific hospitals or doctors; instead, they pay a fixed amount per service, and patients owe any difference if a provider charges more. Consumers must find providers willing to accept the plan’s rates, creating access challenges and potential for large surprise bills. Regulators are urged to ensure real access, and past attempts (e.g., Sidecar Health’s no-network A.C.A. offerings, halted after a 2023 ban) show how contentious and risky this model can be for consumers.