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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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  • Visualizing Health Policy: Health Coverage Under the Affordable Care Act (ACA)

    Other Post

    The December 2012 Visualizing Health Policy infographic is a flowchart illustrating the mechanisms by which people will get health coverage beginning in 2014. See the full-size infographic at The Journal of the American Medical Association. Visualizing Health Policy is a monthly infographic series produced in partnership with the Journal of the American Medical Association (JAMA). Each month’s infographic is freely available on JAMA’s website and is published in the print edition of the journal.

  • New Report Provides State-Level Data on Coverage Gains and Costs of the Medicaid Expansion in Health Reform

    News Release

    Analysis Projects Steep Decreases in Uninsured, With Federal Government Covering Vast Majority of CostsWASHINGTON -- The expansion of Medicaid under the new health reform law will significantly increase the number of people covered by the program and markedly reduce the uninsured in states across the country, with the federal government picking up the overwhelming majority of the cost, according to a state-by-state analysis released today by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU).…

  • Medicaid and Its Role in State/Federal Budgets & Health Reform

    Fact Sheet

    This chartpack from the Kaiser Commission on Medicaid and the Uninsured addresses five key questions about the Medicaid program. They include: What is Medicaid and what does it do? What does Medicaid cost and why? What is Medicaid's role in state budgets? What is Medicaid's role in the federal budget? What is Medicaid's role in health reform? Chartpack (.pdf) Related fact sheet: Medicaid and Its Role In State/Federal Budgets and Health Reform

  • Florida’s Plan to Import Prescription Drugs from Canada, the First of its Kind, May Face Obstacles that Could Delay Implementation and Savings

    News Release

    A new KFF policy watch explains some of the hurdles the state of Florida still must clear before it can implement its novel plan to make some prescription drugs more affordable by importing them from Canada. Florida’s plan represents the first time the Food and Drug Administration (FDA) has granted authority for a state to safely import prescription drugs from another country. However, the state must take some additional steps to move forward with the…

  • The 4 Arguments You Will Hear Against Drug Price Negotiation

    Perspective

    As the Biden administration begins the process of negotiation drug prices for Medicare as authorized in the Inflation Reduction Act, KFF's Larry Levitt probes some of the arguments against it and the policy and political implications of the debate in this New York Times op-ed column.

  • ¿Quién puede comprar un plan catastrófico?

    FAQs

    En general, los planes catastróficos solo se pueden vender a adultos jóvenes menores de 30 años. Sin embargo, existen ciertas exenciones por dificultades económicas y asequibilidad para personas de 30 años o más, incluso si no existe un plan de salud calificado, dentro o fuera del mercado, que cueste menos del 8.05% de sus ingresos en 2026, o si no son elegibles para créditos fiscales para primas o reducciones de costos compartidos según sus ingresos…

  • Issue Brief Examines the Experiences of Five States During Year Two of Affordable Care Act Coverage Expansions

    News Release

    A new issue brief from the Kaiser Family Foundation draws upon 40 in-person interviews conducted with a variety of stakeholders to assess the recent experiences of five states during the second year of coverage expansions under the Affordable Care Act (ACA).  The interviews took place in three states -- Colorado, Kentucky and Washington -- that have State-based Marketplaces, and have adopted the Medicaid expansion, and in two states -- Utah and Virginia -- that rely…

  • I’m 63 and enrolled in a retiree health plan from my former employer. Can I get better coverage and subsidies in the Marketplace instead of staying on retiree coverage?

    FAQs

    Yes, as long as you do so during the Open Enrollment period. However, because you are enrolled in retiree coverage, you will not be eligible for premium tax credits or cost-sharing subsidies for Marketplace coverage. This is true even if the coverage you’re enrolled in is a health reimbursement arrangement (HRA). If you drop your retiree coverage, you may be eligible for financial assistance on the Marketplace depending on your income. However, voluntarily dropping your…

  • I’m working on an H-2A visa. Am I eligible for coverage in the Marketplace?

    FAQs

    Yes. Lawfully-present immigrants who are otherwise eligible for coverage – including “nonimmigrants” like H-2A workers and those on student visas – may purchase insurance in the Marketplace. Those who are low-income and otherwise eligible may also receive premium assistance and cost-sharing reductions to lower the cost of coverage in Marketplace plans. However, DACA is no longer considered an eligible immigration status for health coverage through the Marketplaces, and starting in 2027, certain other lawfully present…