Health insurers have filed 2026 rate requests that would lift premiums on Affordable Care Act exchange plans by about 20% nationwide, according to a Kaiser Family Foundation review of more than 300 regulatory filings. In Florida—where one in five residents buys coverage through the marketplace—companies are seeking a median 18% increase, marking the steepest jump since 2018. Carriers cite a confluence of rising expenses: heavier use of emergency rooms, surging mental-health claims, and blockbuster therapies ranging from GLP-1 diabetes drugs to gene treatments costing more than $2 million. Insurers also expect a less healthy risk pool as enhanced federal tax credits that kept many low-income, generally healthier people enrolled are set to expire on 31 December 2025. The lapse in subsidies, left unresolved in President Donald Trump’s sweeping “Big Beautiful Bill,” threatens to push consumer premiums up as much as 75% and could drive 7.7 million people off coverage by 2034, government and independent forecasts show. Roughly 4 million Floridians and 4.7 million small-business owners nationwide rely on the tax credits, magnifying the stakes for Congress when it returns from recess. Large employers that self-fund medical benefits warn they may shift more costs to workers, while brokers say some marketplace customers are weighing downgrades or dropping insurance altogether. Without legislative action to renew the credits—or offset escalating drug and hospital costs—patients are likely to face higher bills and slimmer coverage when the 2026 plans take effect.