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Did the Affordable Care Act Make Health Care More Affordable?

The expiration of the ACA’s enhanced premium tax credits at the start of 2026, combined with rising insurer premiums, put a spotlight on health care affordability that extends beyond Marketplace enrollees. KFF’s Cynthia Cox examines the ACA’s record and the broader underlying question it raises: what’s a fair price for Americans people to pay for health care?

The ACA MarketplaceS

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

The Average Marketplace Deductible Grew by About $1,000 Per Person in 2026, With More Enrollees Shifting to Higher-Deductible Plans as Enhanced Tax Credits Expired

The average Affordable Care Act (ACA) Marketplace deductible experienced the steepest increase in history—growing by 37% or over $1,000, from $2,759 in 2025 to $3,786 in 2026 as enhanced premium tax credits expired, according to a new KFF analysis. After the enhanced tax credits ended, many Marketplace shoppers shifted toward lower-premium, higher-deductible plans.

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  • Health Insurance Coverage for People with HIV Under the Affordable Care Act: Experiences in Five States

    Issue Brief

    To provide greater insight into how Affordable Care Act (ACA) implementation has affected people with HIV during the first year of major insurance expansions, this issue brief examines the experiences of people with HIV based on focus groups conducted in five states: California, Florida, Georgia, New York, and Texas. It is a part of KFF's larger ACA sentinel sites project.

  • A Perilous Gap in Health Insurance Literacy

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses how progress in expanding coverage requires greater attention to the problem of health insurance literacy.

  • Poll: 4 in 10 Americans Report Losing Their Jobs or Work-Related Income Due to the Coronavirus Crisis, Including More Than Half of Part-Time Workers

    News Release

    Americans, Regardless of Partisan Identity, Prioritize Slowing Coronavirus’ Spread over Restarting the Economy With coronavirus cases rising and businesses shutting down, four in 10 (39%) U.S. residents say they already have lost a job or income due to the crisis, the latest KFF Health Tracking Poll finds. This includes most part-time workers (54%), as well as nearly half of parents with children under age 18 (47%) and those paid hourly or by the job (45%).…

  • Summary of HHS’s Final Rule on Nondiscrimination in Health Programs and Activities

    Issue Brief

    On May 18, 2016, the Department of Health and Human Services (HHS) published a final rule to implement Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination in health coverage and care based on race, color, national origin, age or disability, and, for the first time sex. This Issue Brief provides a technical summary of Section 1557 and the final rule and highlights new protections and provisions included in the law and rule.…

  • Pre-Existing Condition Prevalence for Individuals and Families

    Issue Brief

    This analysis estimates that almost 54 million people – or 27% of all adults under 65 —have pre-existing health conditions that would likely have made them uninsurable in the individual markets that existed in most states before the Affordable Care Act. Almost half (45%) of non-elderly families include at least one adult with such a pre-existing condition. The analysis also includes estimates by age, state and gender.

  • The Democratic Debates Suffer from a Nasty Case of Plan-itis

    From Drew Altman

    In The Washington Post op-ed “The Democratic Debates Suffer from a Nasty Case of Plan-itis,” Drew Altman says the primary debates are not serving voters well by focusing on details of candidates' health care plans rather than the fundamental differences between them.

  • The Silent Affordability Crisis Facing Sick People

    From Drew Altman

    In this Axios column, Drew Altman shows that employer coverage for lower wage workers is much worse than ACA marketplace coverage for similar populations. It’s a bigger problem we need to talk about more, he says.

  • Medicaid Expansion, Health Coverage, and Spending: An Update for the 21 States That Have Not Expanded Eligibility

    Issue Brief

    Ever since the Supreme Court ruled in June 2012 that states could effectively choose whether or not to accept the Affordable Care Act’s expansion of Medicaid eligibility, that choice has been one of the most prominent and often one of the most contentious issues for states. In this report, we provide new projections of the impact of Medicaid expansion on health coverage, Medicaid enrollment, and costs in states that have not expanded Medicaid.