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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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  • My employer doesn’t offer health insurance. Can I buy a plan on the Marketplace and qualify for financial assistance?

    FAQs

    Yes, if your employer does not offer you health insurance, you can shop for a plan on the Marketplace instead. The annual Open Enrollment period to sign up for coverage runs from November 1 to January 15 in most states. Depending on your income and household information, you may qualify for premium tax credits and cost-sharing reductions to help offset your costs. If your income is very low, the Marketplace will also help determine if…

  • I don’t have a checking account. Can the insurance company require that I get one and pay my premiums through automatic monthly withdrawals?

    FAQs

    No. Insurers offering coverage in the Marketplace are required to provide a variety of payment methods and cannot require a consumer to pay by automatic bank withdrawals (sometimes called electronic funds transfers, or EFT) or debit card. Federal rules require the insurer to also accept paper checks, cashier’s checks, money orders, and general-purpose pre-paid debit cards. These methods must be available to consumers for both the initial premium payment (at enrollment) and ongoing payments.

  • Approved Changes in Indiana’s Section 1115 Medicaid Waiver Extension

    Issue Brief

    On February 1, 2018, the Centers for Medicare and Medicaid Services (CMS) approved an amended extension of Indiana’s Healthy Indiana Program 2.0 (HIP 2.0) Section 1115 demonstration waiver. Indiana’s waiver initially implemented the ACA’s Medicaid expansion from February, 2015 through January, 2018 by modifying Indiana’s pre-ACA limited coverage expansion waiver (HIP 1.0). Unlike other states that implemented the ACA’s Medicaid expansion through a waiver, Indiana’s demonstration also changes the terms of coverage for non-expansion adults…

  • Community Health Centers: Growing Importance in a Changing Health Care System

    Issue Brief

    Community health centers provide essential access to comprehensive primary care in underserved communities. This issue brief describes health centers and their patients in 2016 and examines changes in access to care and utilization of services by health center patients following implementation of the ACA coverage expansions in 2014.

  • Kaiser Health Tracking Poll – March 2018: Views on Prescription Drug Pricing and Medicare-for-all Proposals

    Feature

    More than a year into President Trump’s presidency, the March Kaiser Health Tracking Poll gauges the public’s top priorities for the president and Congress to do in the coming months. This month’s poll also measures perceptions on the cost of prescription drugs, attitudes towards policymakers’ actions to address drug prices, and views of pharmaceutical companies. In addition, with the 2018 midterm elections less than 8 months away, the KFF poll asks how important a national…

  • State and Federal Contraceptive Coverage Requirements: Implications for Women and Employers

    Issue Brief

    Before the ACA was passed, many states had enacted contraceptive equity laws that required plans to treat contraceptives in the same way they covered other services. In addition, since the ACA was passed, a number of states have enacted laws that basically codify in state legislation the ACA benefit rules. This issue brief provides an update on the status of the continuing litigation on the federal contraceptive requirement and explains the interplay between the federal…

  • Kaiser Health Tracking Poll – June 2018: Campaigns, Pre-Existing Conditions, and Prescription Drug Ads

    Feature

    The June 2018 KFF Tracking Poll examines the top issues voters want to hear candidates talk about during their 2018 congressional campaigns, including the importance of specific health care positions such as continuing protections for people with pre-existing conditions. The Kaiser poll also examines the public’s views and experiences with prescription drug advertisements and pricing.

  • Proposals for Insurance Options That Don’t Comply with ACA Rules: Trade-offs In Cost and Regulation

    Issue Brief

    This brief examines four options to promote the sale of health plan options in the individual or non-group market that are not subject to Affordable Care Act (ACA) requirements for other major medical health plans. It reviews the trade-offs involved if such loosely regulated markets take root as an alternative to the ACA-regulated market, particularly as the repeal of the individual mandate penalty takes effect next year.