Oregon regulators plan to trim health insurance rate hikes, but premiums are still set to rise

Oregon regulators are proposing to scale back the premium hikes health insurers requested for next year, but people who buy their own coverage or get insurance through a small employer are still on track to face double-digit increases.

The Oregon Division of Financial Regulation is recommending lowering insurers’ requested increases for plans sold through the state’s Affordable Care Act marketplace, commonly known as Obamacare. Their recommendation would reduce increases from an average 17.5% to 16%. For small-group plans covering businesses with 50 or fewer employees, regulators’ trims would lower the average increase from 17% to 15.5%.

Regulators estimate those reductions would save consumers and small businesses about $30 million in premiums next year compared with what insurers originally asked for.

The proposed rates, which won’t become final until September, would apply to individual plans sold by Bridgespan, Kaiser Permanente, Moda Health and Regence BlueCross BlueShield of Oregon. Regulators also reviewed small-group filings from Health Net, Kaiser, Moda, PacificSource, Regence and UnitedHealthcare.

“Increasing insurance rates are part of the rising cost of living felt by many Oregonians,” said Oregon Insurance Commissioner TK Keen. He said regulators “appropriately turned the dial downward” after reviewing insurers’ financial records, medical claims and cost projections.

Even after those reductions, regulators concluded that rising healthcare costs largely justified another year of double-digit premium increases.

Nearly every insurance company pointed to similar forces driving costs higher. They said hospitals and physicians are charging more for care, prescription drug costs continue to climb, and shifting tariff policies cloud how much they will pay for medical equipment and pharmaceuticals. Insurers also expect more people to drop their Affordable Care Act plans.

State officials say the loss of more generous pandemic-era tax credits that helped many people pay their monthly premiums have contributed to declining enrollment.

In Oregon, fewer people buying Obamacare plans now qualify for federal financial assistance. The share receiving subsidies fell from about 80% last year to about 60%, and those who still qualify generally receive less help. Oregonians earning more than four times the federal poverty level — about $62,400 a year for an individual or $128,000 for a family of four — no longer qualify for subsidies.

State data show the marketplace has about 21,000 fewer enrollees this year than at the same point in 2025 — a decline of roughly 15%, compared with an average annual decline of about 1.4% since 2017. Enrollment in the small-group market also fell, from about 142,000 people last year to roughly 134,000 this year.

Keen said the people who stay in the marketplace tend to have higher medical costs, while healthier consumers often leave for employer coverage, Medicare, Medicaid or other options. That leaves insurers spreading costs across a smaller pool with higher average claims, which pushes premiums up.

“Absent the federal subsidies, I don’t know how Oregon or other states easily get out of this dynamic,” Keen said.

Keen said regulators also consulted with Gov. Tina Kotek’s office during the review. He said the governor’s office urged regulators to “take a sharp pencil” to insurers’ filings and make sure “there is no fat in the rates.”

Regulators said they focused their biggest changes on two parts of insurers’ filings. They capped the amount insurers could add to rates to account for a potentially less healthy insurance pool and rejected assumptions that medical cost trends would be higher for small-group plans than for individual plans.

Those changes reduced several insurers’ requested increases. UnitedHealthcare’s proposed increase for its roughly 7,200 small-group members fell from roughly 29% to 20%. Other requests stayed the same after regulators decided they were justified, including PacificSource’s 24% increase, Health Net’s 19% increase and Kaiser Permanente’s nearly 10% increase.

In the individual market, Moda Health still has the largest proposed increase for its 35,210 members, even after regulators lowered the company’s request from 25% to roughly 24%. The other three marketplace insurers’ proposed increases range from 10% to 10.5%.

During a public hearing earlier this month, state officials said their job is not simply to keep premiums as low as possible. By law, regulators have to balance consumers’ interest in affordable coverage with making sure insurers charge enough to pay future claims and stay financially sound.

Public comments highlighted that tension. While insurers argued higher premiums were needed to cover rising medical costs, several Oregonians said they were already struggling to afford coverage.

Diana Burns, a self-employed Beaverton resident, urged regulators to reject Moda’s proposed increase, writing that her household would spend at least 17% of its projected income simply to maintain health insurance.

“That is not sustainable,” Burns wrote. “What I am being asked to pay is not insurance against catastrophic cost — it effectively is the catastrophic cost.”

Donald Snedecor, a Portland retiree, said that health insurance already costs more than his mortgage.

“As much as I like living in Oregon, increasing healthcare premiums at the proposed magnitude will only make retiring in such an expensive state less feasible,” he wrote.

In a statement, Kotek said Trump administration policies have contributed to rising health insurance costs. She said she would work with policymakers to “find solutions that (lower) costs for Oregon families as we navigate changes coming down from the federal government.”

Officials say the state’s reinsurance program, which reimburses insurers for some of their most expensive claims, reduced Obamacare premiums by an average of 10% this year.

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