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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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  • JAMA Forum: The Health Care Law that Continues to Escape Death

    Perspective

    In this November 2017 post for The JAMA Forum, Larry Levitt reviews the status of the Affordable Care Act following actions by the Trump administration widely perceived as designed to undermine the marketplaces. Despite assertions to the contrary, Levitt finds, "at least for now, the ACA seems very much alive."

  • Implications of Emerging Waivers on Streamlined Medicaid Enrollment and Renewal Processes

    Fact Sheet

    The Affordable Care Act (ACA) significantly modernized and streamlined Medicaid enrollment and renewal processes across all states. Through major investments of time, money, and staff, most states have implemented modernized systems that transformed lengthy, paperwork driven enrollment and renewal procedures to a simplified, technology-driven experience that minimizes burdens on individuals and states. Recently approved and proposed waivers and other proposed policies include new eligibility and enrollment requirements and restrictions that run counter to the ACA’s…

  • Digging Into the Data: What Can We Learn from the State Evaluation of Healthy Indiana (HIP 2.0) Premiums

    Issue Brief

    Indiana initially implemented the ACA’s Medicaid expansion through a Section 1115 waiver in February 2015. Indiana’s waiver included important changes from federal law regarding enrollment and premiums. The initial waiver expired, and Indiana received approval for a waiver extension in February, 2018 which continues most components of HIP 2.0 and adds some new provisions related to enrollment and premiums. This brief looks at available data from the state’s evaluation of premiums prepared by The Lewin…

  • American Health Care Act (AHCA) Quiz

    Feature

    On May 4, 2017, the US House of Representatives approved the American Health Care Act (AHCA), legislation to repeal and replace the Affordable Care Act (ACA).  On May 24, the Congressional Budget Office scored the latest version of this bill. Do you think you’re an expert on the AHCA?  Take this quiz to test your knowledge.

  • State Flexibility to Address Health Insurance Challenges under the American Health Care Act, H.R. 1628

    Issue Brief

    The American Health Care Act (AHCA), a bill passed by the House in May 2017 to repeal and replace the Affordable Care Act (ACA), would present states with new authority in individual insurance markets, along with a number of difficult problems and choices and limited resources with which to address them. States would be able to obtain waivers and would be eligible for $123 billion in grant funds, including money from a new Patient and…

  • The Health Care Views and Experiences of Rural Americans: Findings from the Kaiser Family Foundation/Washington Post Survey of Rural America

    Report

    In partnership with The Washington Post, the Kaiser Family Foundation conducted the Survey of Rural America to gauge the views and experiences of people living in small towns and rural areas across the United States, and how they are similar or different from those in urban and suburban settings. This brief explores where health care fits in rural residents' political views, including attitudes toward Republican plans to repeal and replace the ACA as well as…

  • Map: Counties at Risk of Zero Insurers Offering Plans in the 2018 Marketplace

    News Release

    Ahead of the June 21 federal deadline for insurers to submit rates for healthcare.gov, the Kaiser Family Foundation has released a new map that will track counties at risk of zero insurers offering plans in the 2018 marketplace. Compiled from a Foundation analysis of insurer filings and news reports, the map charts the counties at risk of having no insurers based on current public announcements, along with the name of the 2017 participating insurer and…

  • Kaiser Health Tracking Poll – Late April 2017: The Future of the ACA and Health Care & the Budget

    Report

    With the ongoing debate about the future of the Affordable Care Act (ACA), the latest tracking poll examines the public awareness of and attitudes about some recent developments related to the 2010 health care law, including uncertainty about cost-sharing reduction payments and insurers opting out of some health insurance marketplaces. The poll also takes a look at Americans’ budget and health care priorities.

  • Proposed Medicaid Section 1115 Waivers in Maine and Wisconsin

    Issue Brief

    While the future of legislation to repeal and replace the Affordable Care Act (ACA) and make fundamental changes to the structure and funding of the Medicaid program is uncertain, states and the Administration may achieve major changes to Medicaid through the use of Section 1115 Medicaid waivers. Wisconsin submitted a waiver amendment request to CMS in June 2017 and Maine submitted a waiver application to CMS in August 2017. Unlike previous waivers that encompass the…

  • State-by-State Estimates of Reductions in Federal Medicaid Funding Under Repeal of the ACA Medicaid Expansion

    Issue Brief

    Congressional debate around the Affordable Care Act (ACA) has recently included a proposal to repeal the ACA, including the provision allowing states to extend Medicaid to childless adults up to 138% FPL and providing enhanced federal funds for the Medicaid expansion. This brief provides estimates of changes in federal Medicaid funds and Medicaid coverage for adults covered through the ACA expansion if the expansion is eliminated starting in 2020. A repeal of the Medicaid expansion…