Affordable Care Act

About the ACA

Promotional image for KFF video How Affordable is the Affordable Care Act

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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  • Survey Finds Most Marketplace Enrollees Like Their Coverage, Though Satisfaction with Premiums and Deductibles Has Declined Since 2014

    News Release

    Following the Affordable Care Act’s (ACA) third open enrollment period, a new Kaiser Family Foundation survey of people who buy their own health insurance finds most marketplace enrollees give their coverage good marks, though concerns about premiums, deductibles, and other costs have risen since 2014. The survey, the third in a series, finds about two thirds (68%) of marketplace customers rate their current coverage as either “excellent” or “good.” Although concerns about narrow network plans…

  • CMS Requires More Restrictive Definition of Medical Frailty in New Medicaid Work Requirements Rule

    Quick Insights

    On June 1, 2026, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule on Medicaid work requirements that adopts a restrictive definition of medical frailty—differing from states’ early expectations. The more restrictive definition of medical frailty adopted by the Trump Administration will be challenging for states to implement and could lead to more people falling through the cracks and losing coverage.

  • Pulling It Together: Writing Regulations

    Perspective

    Not since Geraldo Rivera revealed the secret contents of Al Capone's vault on national TV in the mid-80s, or more recently, sports fans awaited the LeBron James "decision" about where he would play next, have we so anxiously awaited anything as much as the draft health exchange regulations just published by HHS. Well, okay, I exaggerate for effect, but the regulations on health insurance exchanges were anxiously awaited by the health policy community. The hallmark…

  • How Much Will Medicaid Physician Fees for Primary Care Rise in 2013? Evidence from a 2012 Survey of Medicaid Physician Fees

    Issue Brief

    This brief presents 50-state data from the 2012 KCMU/Urban Institute Medicaid Physician Fee Survey. It estimates that average Medicaid fees to qualified physicians for Affordable Care Act primary care services will rise by 73 percent when the primary care fee increase takes effect on January 1, 2013, although there will be wide state variation. The paper presents data showing how states compare in their 2012 Medicaid fee levels, how Medicaid fees compared to Medicare fees,…

  • The U.S. Economy and Changes in Health Insurance Coverage, 2000-2006

    Other Post

    Health Affairs Article: The U.S. Economy and Changes in Health Insurance Coverage, 2000-2006 A Foundation study featured as a web-exclusive Health Affairs article examines health coverage trends from 2000-2006 showing that over this period the dominant factor contributing to a rise in the uninsured population has been the decline in employer-sponsored insurance, even as the economy rebounded from the last recession. Access web-exclusive Health Affairs article

  • The Fraying Link Between Work and Health Insurance: Trends in Employer-Sponsored Insurance for Employees, 2000-2007

    Report

    This analysis shows that employer-sponsored coverage began declining after 2000 due to an economic downturn that saw rising unemployment, declining family incomes and more workers moving into temporary work, part-time work and other employment arrangements where health benefits were not provided. Employer-sponsored coverage continued to decline after 2003 despite improvements in the economy and slower growth in health care costs. The decline in coverage was due both to falloffs in the share of employees with…