American families, promised they would save $2,500 a year on health insurance premiums, are bracing themselves to see just how much their costs will increase again next year.

Health insurers across the country are seeking premium increases of 20% to 40% or more. Some carriers requested only modest increases, largely because they priced premiums in line with expected medical expenses in the first year. But many others found enrollees are sicker and more costly than anticipated.

Blue Cross and Blue Shield of New Mexico requested a 52% increase for 2016 individual plans, but the hike has been denied by the state’s insurance regulator.

President Obama is jawboning regulators to lower rates, but that can only go so far when plans face multimillion dollar gaps between premium income and claims payments.