Obamacare enrollment has been increasing to a record high over the past several years, but high costs for your 2026 plan has shocked the community.

Obamacare/Marketplace participation hits record levels — but skyrocketing medical costs, expiring subsidies, and insurer rate hikes threaten affordability; experts say it’s time to consider HSAs and price transparency

WILMINGTON — Delaware is experiencing its highest Affordable Care Act enrollment since the program launched, but the celebration comes with a warning: the state’s health-care costs are rising so sharply that many residents may soon see their premiums double.

More than 53,000 Delawareans are enrolled in the ACA marketplace for 2025 — up from about 23,000 in 2019 — representing a dramatic expansion of coverage and a significant shift in how individuals and families access insurance. Yet behind these record numbers lies a growing affordability crisis driven not by state policy, but by medical inflation, increased utilization of care and structural costs embedded in the health-care system.

For many middle-income Delawareans, the math is simple and sobering: premiums that averaged around $700 a month last year could soon exceed $1,400 when enhanced federal subsidies expire in late 2025. And even with subsidies, Delaware’s underlying premium increases — among the steepest in the country — raise serious questions about whether the system is sustainable.

Enrollment rises, but so do premiums

Delaware’s ACA enrollment trajectory reflects impressive demand:

But the same period also brought some of the largest premium hikes Delaware has ever seen. Insurers received approval for increases far above the national average:

• Highmark Blue Cross Blue Shield: +25%

• AmeriHealth Caritas: requested 46%, approved for +34.98%

With inflation cooling in most sectors of the economy, many Delawareans are asking: why are health-care costs going in the opposite direction? And why is Delaware being hit harder than other states?

Why Delaware’s health-care costs are climbing so fast

Rate filings submitted to state regulators offer a candid picture of what insurers say is driving these increases. The pressures fall into several major categories:

1. Medical costs are rising faster than inflation

Hospitals and physicians continue to raise prices, especially in high-cost specialties such as oncology, cardiology, emergency care and surgery. Specialty and biologic drugs — which now account for a significant share of total pharmacy spending — are increasing at double-digit rates.

2. More people are using more care

Since the pandemic, Delawareans have returned to the health-care system in force. Elective procedures are up, chronic conditions are being treated more intensively and demand for mental-health services has surged.

New diagnostic tools and technologies also improve care but come with higher price tags.

3. Labor shortages are driving up hospital expenses

Hospitals across Delaware face workforce shortages, particularly among nurses, technicians and support staff. To maintain staffing, providers are resorting to overtime, bonuses and travel-nurse contracts — all of which significantly increase operating costs.

Those costs are ultimately passed on in the form of higher premiums.

4. Delayed care is becoming more expensive care

Thousands of Delaware residents postponed screenings and treatment during 2020–2021. They are now returning with more advanced conditions, raising average claims costs per patient.

5. Reinsurance and federal formulas are adding cost pressure

Insurers must purchase reinsurance to protect against catastrophic claims — and those protections are becoming more expensive. Federal risk-adjustment formulas also shift money among insurers depending on the health status of their enrollees, adding unpredictability.

6. Medicaid “unwinding” is reshaping the risk pool

As temporary pandemic rules end, many Delawareans are losing automatic Medicaid eligibility and moving back into private plans. This often brings sicker, higher-cost individuals into the marketplace.

7. The healthier you are, the more likely you are to leave

As premiums rise, younger and healthier people disproportionately drop coverage. That leaves insurers with a smaller, sicker, and more expensive population, which forces rates up again — a cycle actuaries call a “death spiral.”

Casscells: Delaware’s cost crisis reflects a deeper structural problem

Retired orthopedic surgeon Dr. Chris Casscells, a policy adviser with A Better Delaware, argues these skyrocketing costs are symptoms of a system that gives patients almost no visibility into prices — and no incentive to shop.

“The Affordable Care Act separated the patient from the actual cost of care,” Casscells says. “Nobody knows what anything costs. Hospitals inflate list prices because reimbursement formulas reward it. Insurers react by raising premiums. And patients are stuck in the middle with no ability to compare or negotiate.”

Casscells believes Delaware’s cost crisis cannot be solved by subsidies alone because subsidies disguise, rather than reduce, the real price of medical care.

“Delaware is drowning in complexity. We need reforms that give patients more control, not more layers of bureaucracy,” he said.

Who really pays for Obamacare in Delaware?

Although enrollment is administered at the state level, the federal government pays:

Delaware pays the remaining 10% of expansion and its regulatory overhead.

This means Delawareans are not facing higher premiums because the state is charging more — but because the cost of care itself is rising far faster than insurers can absorb.

A looming affordability cliff in 2026

The biggest threat on the horizon is the scheduled expiration of enhanced federal subsidies at the end of 2025. These subsidies temporarily discounted premiums for thousands of families.

If Congress does not extend them, the impact could be dramatic:

• A family paying $600–$800/month today could face $1,400+/month in 2026

• Thousands may drop coverage

• Delaware’s uninsured rate could rise for the first time in a decade

• The marketplace could destabilize as healthier enrollees exit

For middle-income families — those earning too much for Medicaid but unable to afford unsubsidized coverage — the risk is significant.

Is it time to rethink the model? HSAs and true price transparency

While some lawmakers argue for new rounds of subsidies, Casscells and other center-right policy advocates say Delaware should strengthen consumer-driven health-care tools instead of expanding dependence on federal aid.

Two strategies top the list:

1. Health Savings Accounts (HSAs)

HSAs allow individuals to:

• Save tax-free

• Spend on health-care expenses they choose

• Build long-term savings for future medical needs

• Shop for lower-priced providers and services

Supporters argue that HSAs create incentives that the current system lacks: comparison-shopping, cost awareness and personal responsibility. They also offer families an alternative to high premiums by pairing HSAs with lower-cost, high-deductible plans.

2. Real price transparency

Casscells and A Better Delaware say Delaware should require hospitals and providers to publicly post prices for common procedures — MRIs, X-rays, surgeries, tests — allowing patients to compare costs just as they would for any other major purchase.

“Until Delawareans know what care actually costs, affordability will always be an illusion,” Casscells said.

Editor’s Fact Check: Why premiums are doubling

Premiums for many ACA customers are increasing by 100% or more due to:

• Expiring federal subsidies

• Insurer rate hikes of 25%–35%

• Rising medical costs and higher utilization

• A shrinking risk pool as healthy enrollees exit

Example: A family paying $700/month in 2024 may pay more than $1,400/month in 2026 without renewed subsidies.

The bottom line

Delaware’s ACA marketplace is larger than ever — but also more expensive than ever to maintain. Enrollment continues to rise, yet premiums are rising even faster, revealing the state’s growing dependence on federal subsidies and a health-care system struggling under its own weight.

As Delaware approaches a potential affordability cliff in 2026, policymakers face a choice: continue relying on temporary subsidies to mask the cost of care, or pursue reforms — like HSAs and true price transparency — that give patients more control and may ultimately slow the relentless rise of health-care costs.

Delaware LIVE collaborates with a network of professional journalists to cover a diverse range of stories across various fields.  Staff Writers include experienced journalists and young professionals.  If you have questions, please feel free to contact editor@delawarelive.com or our publisher, George D. Rotsch, at George@Delawarelive.com