Although seagrasses and marine macroalgae (macro-autotrophs) play critical ecological roles in reef, lagoon, coastal and open-water ecosystems, their response to ocean acidification (OA) and climate change is not well understood. In this review, we examine marine macro-autotroph biochemistry and physiology relevant to their response to elevated dissolved inorganic carbon [DIC], carbon dioxide [CO₂], and lower carbonate [CO₃²⁻] and pH. We also explore the effects of increasing temperature under climate change and the interactions of elevated temperature and [CO₂]. Finally, recommendations are made for future research based on this synthesis. A literature review of >100 species revealed that marine macro-autotroph photosynthesis is overwhelmingly C₃ (≥ 85%) with most species capable of utilizing HCO₃⁻; however, most are not saturated at current ocean [DIC]. These results, and the presence of CO₂-only users, lead us to conclude that photosynthetic and growth rates of marine macro-autotrophs are likely to increase under elevated [CO₂] similar to terrestrial C₃ species. In the tropics, many species live close to their thermal limits and will have to up-regulate stress-response systems to tolerate sublethal temperature exposures with climate change, whereas elevated [CO₂] effects on thermal acclimation are unknown. Fundamental linkages between elevated [CO₂] and temperature on photorespiration, enzyme systems, carbohydrate production, and calcification dictate the need to consider these two parameters simultaneously. Relevant to calcifiers, elevated [CO₂] lowers net calcification and this effect is amplified by high temperature. Although the mechanisms are not clear, OA likely disrupts diffusion and transport systems of H⁺ and DIC. These fluxes control micro-environments that promote calcification over dissolution and may be more important than CaCO₃ mineralogy in predicting macroalgal responses to OA. Calcareous macroalgae are highly vulnerable to OA, and it is likely that fleshy macroalgae will dominate in a higher CO₂ ocean; therefore, it is critical to elucidate the research gaps identified in this review.