2027 Rate Changes - Arkansas: +6.0% indy market; +8.9% small group market

Thu, 08/27/2026 - 3:27pm

ACA exchange enrollment has dropped by 10% in Arkansas since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were only down 3.8% vs. OEP 2025...but effectuated enrollment was down over 8% year over year in January and by 10% (around 14,000 enrollees) as of February.

I suspect that the main reason it has only dropped by 10% vs. much higher drops in many other states is thanks to their newly-implemented, robust Premium Alignment pricing policy, which I wrote about multiple times last fall.

In fact, there are three states which newly launched Premium Alignment pricing this year (Arkansas, Illinois and Washington State)...and all three of them saw less net attrition through February than most states did nationally, for whatever that's worth:

Arkansas: Down 10.0%
Illinois: Down 0.4%
Washington: Down 8.8%
National Avg w/out AR/IL/WA: Down 12.3%

Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:

Looking ahead to 2027, the preliminary rate filings for both the individual and small group markets are now available via the federal Rate Review database.

UNFORTUNATELY, I've only been able to find actual effectuated enrollment data for two of the six carriers offering individual market coverage this year...and it looks like two of the remaining four are pulling out of the market entirely next year.

Via this Arkansas Democrat Gazette article:

Insurers offering plans on Arkansas' Affordable Care Act marketplace have proposed rate increases ranging from 3.1% to 15.9% for 2027, down significantly from the increases that were approved for this year.

Arkansas Blue Cross and Blue Shield, whose plans covered more than 175,000 people on the marketplace last year, proposed increases ranging from 10.5% for a set of plans offered through its HMO Partners Inc. affiliate to 3.1% for plans offered through USAble HMO Inc., according to information posted on healthcare.gov.

...Similarly, St. Louis-based Centene Corp. proposed a 15.9% increase for plans offered through QCA Health Plan Inc., which covered 52,500 people on the marketplace last year.

...Two other Centene subsidiaries, Celtic Insurance Company and QualChoice Life and Health Insurance Company Inc., were not among the companies that filed proposed rates for next year.

...Enrollment figures accompanying next year's proposed increases were not available on healthcare.gov or included in the companies' redacted rate filings.

If the companies were to occupy the same relative market share as they did last year, the average increase next year, pending approval, would be about 8.8%.

Actually, this isn't completely accurate: The filing for QCA Health Plan (Centene) specifies 37,079 enrollees as of spring 2026, while the filing for USAble Mutual (AR BCBS) lists 107,724 enrollees.

Plans offered through the marketplace were covering about 131,000 people who were enrolled through healthcare.gov as of July 15, according to the Insurance Department.

This is interesting as it's almost identical to the ~130,000 effectuated enrollees as of February...meaning that in Arkansas, at least, enrollment has not only remained stable for most of the year after the initial drop, it has actually increased slightly. Huh.

There's another important factor in Arkansas, however: It's the only state which has a unique "Private Option" setup for ACA Medicaid expansion, in which residents who would normally be enrolled in Medicaid coverage are enrolled in off-exchange ACA indvidual market plans instead, with the state using a combination of federal Medicaid expansion funding plus some wraparound state funding to cover the cost.

This group of enrollees aren't counted as ACA enrollees because they're technically enrolled "off-exchange," but they are counted for purposes of the annual rate filings and risk pool, so they have to be added to the total:

The plans also covered 163,452 people through the state's Medicaid expansion program, ARHOME, which stands for Arkansas Health and Opportunity for Me.

The annual rate filings are usually based on enrollment as of March or April, however, so I had to get the number from the state Medicaid Dept's March report... 179,637.

If you futher assume that perhaps 10% or so of the non-ARHOME individual market enrollment is off-exchange, that gives a total of ~130,000 + ~180,000 + ~20,000 or around 330,000 total statewide.

...Among the factors that drove the increases approved for this year was the expiration of enhanced subsidies established in response to the COVID-19 pandemic through the American Rescue Plan Act of 2020.

With the expiration of the enhanced subsidies making coverage more expensive for consumers, insurers some people would drop their coverage and that they would tend to be healthier than those who were willing to pay the higher premiums.

The good news is that this gives me at least a rough total market figure to work with. When I subtract the 144,803 enrolled via QCA and USAble, that leaves around 185,000 across the four remaining carriers...two of which are leaving the market.

Since I have no idea what the actual enrollment breakout is across them, I've divided it evenly, assuming ~46,300 apiece, which gives a semi-weighted average preliminary 2027 rate increase of around 6.0%...which, if accurate, would be the lowest average 2027 premium increase for unsubsidized enrollees in the country.

On the other hand, if you disregard all of that and just go by the unweighted average, it would be more like 9.1% marketwide.