8 Healthcare Topics to Watch in 2027

The Peterson-KFF Health System Tracker publishes some of the most rigorous independent research on U.S. health spending, coverage, and access. Looking at what their researchers are focused on right now reveals which forces will most reshape the insurance market in the year ahead. Below are the eight developments that will matter most to people making coverage decisions in 2027, drawn directly from HST data and the trends their analysts flagged as inflection points.

Starting in 2027, most non-elderly, non-disabled Medicaid adults will be required to verify 80 hours per month of work, job training, or community service to maintain coverage. This is not hypothetical legislation, it is now federal policy, and states are under pressure to implement verification systems that do not yet exist at scale.

Peterson-KFF research is explicit about where the losses will fall. Most people who lose Medicaid under work requirements will not become employed, they were already working informally, caregiving, or experiencing episodic employment that is hard to document. The majority will simply lose coverage and fall into the uninsured population.

For the marketplace, the 2027 work requirement rollout creates two forces pulling in opposite directions. Some former Medicaid enrollees will qualify for ACA subsidies and enter the marketplace. But a larger group will become uninsured, reducing the overall risk pool in certain markets and potentially affecting future premiums.

Separate from work requirements, federal legislation has included Medicaid funding reductions projected at roughly $900 billion over a decade. States fund Medicaid on a shared basis with the federal government, so federal cuts translate directly into state budget shortfalls that governors must address through some combination of benefit reductions, eligibility changes, provider rate cuts, or general revenue increases.

The populations that consume the most Medicaid spending, elderly dual-eligibles and disabled adults, are exempt from work requirements. That means work requirement savings are limited, while the larger structural cuts fall on all eligibility groups. States that have already expanded Medicaid face particularly difficult choices, since rolling back expansion would leave large numbers of adults uninsured and might trigger federal matching rate penalties.

The Peterson-KFF Health System Tracker analyzed publicly available 2027 rate filings from 77 insurers across 16 states and the District of Columbia. The median proposed increase is 14%, the second-highest requested change since 2018, following 2026's 18% proposed increase. Not one of the 77 insurers proposed a decrease. The range spans 1% to 52%, meaning some marketplace enrollees face potential premium increases exceeding half their current cost.

Subsidies provide substantial protection for the 87% of marketplace enrollees who qualify for premium tax credits, the credit scales upward as the benchmark premium rises, insulating most subsidized enrollees from the full increase. But two groups face significant exposure:

• Unsubsidized enrollees (roughly 13% of marketplace): bear the full premium increase with no offset. At the 14% median, someone paying $600/month now faces $684 in 2027.
• People near subsidy cliffs: income changes that push a household above the subsidy threshold mean absorbing the full premium increase retroactively at tax time.

GLP-1 receptor agonists, drugs like Ozempic, Wegovy, Mounjaro, and Zepbound, were a niche diabetes treatment five years ago. They are now a mainstream weight-loss option with utilization growing faster than any insurer's actuaries projected. Peterson-KFF Health System Tracker research documents the cost trajectory based on insurer filings:

The strategic response varies sharply by carrier. Some plans have eliminated GLP-1 coverage for weight loss entirely to control costs, offering lower premiums but leaving members who use the drugs to pay out of pocket, often $800–$1,400/month at retail price. Other carriers retain coverage and spread the cost across all members. In 2027, this coverage difference will be one of the most consequential distinctions between otherwise similar plans.

The longer-term question HST researchers are tracking: GLP-1s demonstrably reduce cardiovascular events and hospitalizations in long-term studies. If plans that cover these drugs see lower downstream costs (fewer heart attacks, fewer diabetes complications), the calculus on coverage changes. 2027 will be too early for insurers to credit those savings in their actuarial models, but the debate will intensify.

Hospital and physician consolidation has been accelerating for over a decade. The Peterson-KFF Health System Tracker documents the current state: in approximately 50% of U.S. metropolitan areas one or two health systems control all inpatient commercial hospital care. That is not a competitive market, it is a market where a single system can demand whatever reimbursement rate it chooses, knowing that the insurer cannot simply exclude the only hospital within 50 miles.

On the insurer side, concentration is just as pronounced. In Alabama, Blue Cross Blue Shield holds 94% of the large group market. In Iowa, Wellmark holds 90% of individual market share. In Delaware, Highmark controls 93% of individual market enrollment. In markets like these, there is no competitive pressure on premiums from the insurer side either.

Price transparency requirements, discussed in the next section, are intended to introduce at least information-based pressure into these markets. But transparency does not by itself create alternatives. A patient in a county served by one hospital system cannot shop to a competitor regardless of what the price list shows.

Hospital price transparency requirements, enacted in 2021 but poorly enforced through 2024, are gaining real teeth. The Peterson-KFF Health System Tracker has tracked compliance closely, and the Patients Deserve Price Tags Act has bipartisan Senate support that increases the likelihood of passage in 2026 or 2027. The legislation would require insurers, not just hospitals, to disclose negotiated rates in machine-readable format.

True price transparency matters more than compliance percentages suggest. Even hospitals that technically post machine-readable files often post incomplete or unusable data. HST researchers have documented that the same procedure can vary 3x to 7x in negotiated price within a single metro area, information that could shift patient volume significantly if patients could actually see it before scheduling.

The federal Rural Health Transformation initiative represents the largest dedicated rural healthcare investment in decades: $50 billion over five years, with $10 billion in awards made in 2026. Individual state awards in the first round ranged from $147 million to $281 million. The funds target telehealth expansion, remote patient monitoring infrastructure, and rural hospital sustainability, addressing a crisis that Peterson-KFF data has documented extensively.

Rural hospital closures have an outsized effect on insurance markets. When a rural hospital closes, patients must travel farther for care, but insurance networks are built around facility proximity. A plan that listed the now-closed hospital as an in-network option may leave enrollees with no in-network facility within a reasonable distance, forcing out-of-network costs or long-distance care. In 2027, rural residents should verify that the facilities anchoring their plan's network are still open and still in-network.

Peterson-KFF Health System Tracker research on how healthcare spending is distributed across the population reveals a pattern that has direct implications for how people should choose plans. Healthcare spending is not normally distributed, it is highly concentrated among a small share of the population in any given year.

The average person in the bottom half of the spending distribution spends $433 per year on healthcare, less than $37 per month. The average person in the top 1% spends $150,467. Approximately 14% of the population had zero healthcare spending in 2023.

This concentration has two practical implications for 2027 plan selection:

1. Most people in most years benefit from lower-premium plans. If you are consistently in the bottom half of spending, no hospitalizations, no chronic conditions requiring expensive management, the premium savings from a Bronze plan will exceed your out-of-pocket costs in most years. The out-of-pocket maximum protects you in the exceptional year when that changes.
2. Chronic conditions and age dramatically shift the calculus. Adults 55+ account for 57% of total health spending while representing 30% of the population. Adults with cancer average over 3x the spending of those without. Hypertension nearly doubles expected spending. If you carry one of these conditions, the lower deductibles and broader coverage of a Gold plan often cost less in total than a Bronze plan despite higher premiums.

The Common Thread: 2027 Is a Year to Be Active, Not Passive

Every one of these eight trends points in the same direction. Auto-renewing your 2026 plan for 2027 is likely to cost you more than actively comparing options during Open Enrollment (November 1, 2026 through January 15, 2027). Medicaid enrollees need to understand what verification is required to keep coverage. ACA enrollees need to know if their carrier is still competitive in their ZIP code. Anyone on a GLP-1 needs to check the formulary. Anyone in a rural area needs to verify their hospital network.

The difference between someone who engages with these changes and someone who does not is not a small one. Peterson-KFF data consistently shows that people who shop actively during Open Enrollment pay substantially less, and get coverage more appropriate to their actual health needs, than those who do not.