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People attending a healthcare rally in Maryland. Photo: Tim Sloan/AFP via Getty Images

Get ready for about six more months of headlines like this: Insurers in Maryland are proposing premium hikes as high as 91% for coverage sold through the Affordable Care Act.

Why it matters: This will keep happening, nationwide. Proposed increases have been steep in Maryland and Virginia, the first two states to release them. But all signs point to steep hikes across the country, especially in rural areas. Some insurers also will likely decide to simply quit offering coverage in some parts of the country.

The latest: Insurers in Maryland’s individual market are seeking rate hikes for next year that range from 18% (for the biggest plan in the state) to 91% (for the smallest). They average out to roughly 32%.

  • These rates are still preliminary — Maryland can approve or reject proposed increases, and it’s also pursuing a reinsurance program that would help bring these increases down.

Why you'll hear about this again: More preliminary rates will trickle out until the summer, as will any insurers' decisions to pull up stakes in some markets. After negotiations with state regulators, rates will be finalized a few weeks before the midterms.

  • Expect to hear Democrats making hay of these increases as they accuse Republicans of “sabotaging” the ACA.
  • There’s really no denying that the repeal of the ACA’s individual mandate, coupled with some of the Trump administration’s regulatory moves, is a big driver — though not the only driver — of these staggering increases.

The other side: Expect the Trump administration to cite these same figures as it finalizes regulations that would loosen access to options outside the ACA’s exchanges, saying they're providing new options to people who simply can't afford ACA coverage.

  • Don't forget, though, that some of those options would only benefit the healthiest consumers.

Go deeper

Right-wingers making McCarthy sweat for future Speaker post

House Minority Leader Kevin McCarthy stands with his Republican colleagues outside the House on Nov. 17. Photo: Stefani Reynolds/Bloomberg via Getty Images

Right-wing elements in the Republican Party are complicating House Minority Leader Kevin McCarthy's attempts to become the next speaker of the House should the GOP take back the majority in 2022.

Why it matters: While McCarthy has worked carefully to build trust among the conservatives who tanked his chances at clinching the speakership in 2015, they're still circling ahead of the next Speaker vote in January 2023.

2 hours ago - Politics & Policy

Congress sprints to meet crush of deadlines

Illustration: Aïda Amer/Axios

Congressional leaders have been pushing off vital action for months — and a lot of it will catch up with them in December, which begins Wednesday.

Driving the news: Funding for the federal government is set to expire at midnight on Friday. There are also consequential deadlines related to the debt limit, President Biden's agenda and annual actions like voting on the National Defense Authorization Act.

2 hours ago - World

U.S. fears Iran won’t scale back to 2015 nuclear deal

Officials gather in Vienna on Sept. 29 for the first day of renewed nuclear talks with Iran. Photo: EU Vienna Delegation/Handout/Anadolu Agency via Getty Images

U.S. officials have extremely low expectations as world powers resume negotiations with Iran to curb its nuclear program, believing the Iranians aren't yet ready to negotiate seriously, Axios is told.

Driving the news: Senior officials in the U.S. intelligence community have assessed the new Iranian president, Ebrahim Raisi, thinks of his predecessor, Hassan Rouhani, as a weak accommodationist who negotiated a bad deal with the U.S. and other world powers in 2015.