Health insurance premiums in the Obamacare marketplaces are expected to increase by an average of 13 percent in 2027, affecting millions of Americans who rely on the program for coverage, according to an analysis released by KFF on Friday.

The increase follows a steep rise that has already led millions of people to drop their coverage since last year. KFF calculated the national figure using new 2027 prices published by the Trump administration for 30 states whose marketplaces are managed by the federal government, along with data from states operating their own exchanges.

Higher medical costs nationwide account for much of the increase. The new prices also come after tax credits that helped consumers afford marketplace plans expired under the Trump administration. The administration has additionally introduced new enrollment barriers as part of an effort to address what it describes as widespread fraud.

The expected increases are broadly similar to those forecast in other health insurance markets, although the Obamacare rise is slightly higher. Several consulting firms have projected that employer-sponsored plans, which cover about 150 million people, could see premiums increase by roughly 10 percent in 2027. Premiums for federal workers are also rising by more than 10 percent.

Health care affordability remains a major concern for voters ahead of Tuesday’s midterm elections. In a recent KFF poll, about 60 percent of registered voters said they were worried about being able to afford health care for themselves and their families.

Sources: The New York Times Health.