Post-pandemic Affordable Care Act premium hikes on the horizon

• But enrollees who don't qualify for federal help certainly will, and experts say the factors driving the increases are likely to show up in employer-sponsored coverage, too.

Driving the news: Most health insurers in the individual market are seeking median premium increases between 5% and 14% in 2023, according to a Kaiser Family Foundation survey of preliminary filings from 72 health plans across 13 states and the District of Columbia.

• The increases have less to do with COVID-19 or federal policy changes than rising prices paid to hospitals, doctors and drug companies and and the expectation enrollees will be using more health services, KFF said.
• The rate hikes would follow several years of flat premiums in ACA markets.
• Final rates won’t be firmed up until the fall, and states could still pare back some of the insurers' requests.

Go deeper: ACA coverage has been a focal point in Congress after Democrats' coronavirus relief package last year made premium assistance more generous and expanded eligibility to more middle-income Americans, but only temporarily.

• Families covered in marketplace plans pay no more than 8.5% of their income on health insurance.
• Democrats are rushing to cut a deal that could extend the beefed-up assistance for two years and forestall a subsidy cliff that could surge the uninsured population at the end of this year.
• Some healthier people could exit the individual markets if the enhanced subsidies expire, leaving a sicker pool of enrollees that could drive costs higher, said Cynthia Cox, vice president at KFF.

KFF's survey found the political machinations won’t have as much of a bearing on health costs as increased demand from consumers who deferred care during the pandemic, and surging labor and supply costs.

• Many insurers are projecting an upward cost trend of 4 to 8%, driven by more demand for services and higher payments to hospitals, doctors and drug companies.
• Most of the carriers didn't break out their big cost-drivers in the rate filings, though experts anticipate strong demand for mental health services and telemedicine in some specialty areas.

The other side: Insurers say Congress holds the key to whether individual coverage remains affordable for nearly 20 million people.

• "If Congress does not take action to extend the American Rescue Plan Act enhanced subsidies, this will be the greatest factor impacting affordability of out-of-pocket premiums for plan year 2023," said David Allen, a spokesperson for America's Health Insurance Plans.

Reality check: ACA marketplaces have been stable and profitable for insurers, even if individual market enrollees tend to be sicker than they were pre-ACA.

• Insurers were largely insulated from COVID-19's toll, in large part because people delayed other care. Carriers that had to pay more medical claims raised premiums on employers and consumers.
• KFF found the pandemic will have a neutral or slight impact on health costs and premiums, mostly driven by costs associated with administering vaccines and boosters.
• Inflation in the health care sector has not grown as fast as in the rest of the economy, a June Kaiser analysis found, but insurers are concerned how long this holds.

Our thought bubble: Washington has generally been reluctant to tackle rising health care costs, which would require taking on powerful industry interests.

• Democrats' push to lower drug prices is the highest-profile exception, and their renewed effort to allow a modest version of Medicare negotiations with drugmakers will serve as a test of their resolve.