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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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  • Assessing the Performance of the U.S. Health System

    Issue Brief

    Health spending growth has consistently outpaced U.S. economic growth and is higher than medical spending in other wealthy countries. Despite spending more, the United States doesn't have better health outcome in terms of life expectancy, mortality rates and other measures. This brief provides an overview of trends in health costs and the performance of the U.S. health system, including comparisons to countries from the Organisation for Economic Co-operation and Development (OECD). The brief charts growth…

  • Key Findings on Medicaid Managed Care: Highlights from the Medicaid Managed Care Market Tracker

    Report

    This report highlights 10 key findings on the Medicaid managed care market, based on analysis of data included in the Kaiser Family Foundation's Medicaid Managed Care Market Tracker. The findings provide a partial profile of the Medicaid MCO market nationally and by state. They also illuminate the involvement of large, multi-state health insurance companies in the Medicaid market and the participation of these firms in other markets as well, including the managed long-term services and…

  • Health Insurance Explained: The YouToons Have it Covered

    Video

    In this five-minute animated video, the YouToons help consumers understand their health insurance through fun, easy-to-understand explanations and scenarios. This cartoon serves as a tutorial for consumers and organizations. The YouToons previously appeared in the 2010 animated movie, "Health Reform Hits Main Street" and the 2013, "The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act."

  • JAMA Forum: Why Health Insurance Literacy Matters

    Perspective

    Larry Levitt's November 2014 post looks at the challenges with people not understanding basic health insurance concepts as millions of them evaluate and choose health plans during open enrollment season for insurance in 2015.

  • Estimating Federal Payments and Eligibility for Basic Health Programs: An Illustrative Example

    Report

    In some states, policymakers and stakeholders are considering adoption of the Basic Health Program (BHP) option permitted under the Patient Protection and Affordable Care Act (ACA). Federal regulations allow BHP implementation beginning in 2015. Through BHP, consumers with incomes at or below 200 percent of the federal poverty level (FPL) who would otherwise qualify for subsidized qualified health plans (QHPs) offered in health insurance marketplaces instead are offered state-contracting standard health plans that provide coverage…

  • The ACA’s Basic Health Program Option: Federal Requirements and State Trade-Offs

    Report

    The Patient Protection and Affordable Care Act (ACA) gives states the option to implement a Basic Health Program (BHP) that covers low-income residents through state-contracting plans outside the health insurance marketplace, rather than qualified health plans (QHPs). In March 2014, the Centers for Medicare & Medicaid Services (CMS) issued final regulations on the requirements for a BHP and the methodology for calculating federal payments to states. States can choose to implement BHP beginning in 2015.…

  • Mapping Marketplace Enrollment

    Interactive

    This interactive zip code tool and map displays enrollment in the Health Insurance Marketplaces as a share of the potential market in small geographic areas across the country.

  • Following Midterms, Both Democrats and Republicans Expect Washington to Continue to Debate the Affordable Care Act, But the Public Is Splintered Over What Congress Should Do

    News Release

    About Half of Uninsured Expect To Find Coverage in the Coming Months, Though Another Quarter Say They Won't Because They Do Not Believe They Can Find an Affordable Plan Following the Nov. 4 midterm elections that saw Republicans seize control of the Senate and expand their House majority, nearly half of Americans (47%) expect increased debate between the two parties over the Affordable Care Act, according to the Kaiser Family Foundation's latest tracking poll. In comparison,…

  • Kaiser Health Policy News Index: November 2014

    Feature

    The Kaiser Health Policy News Index is designed to help journalists and policymakers understand which health policy-related news stories Americans are paying attention to, and what the public understands about health policy issues covered in the news. According to this month’s index, the public remains captivated by news coverage of the Ebola virus. Fewer, but still substantial shares, report following the conflicts in Iraq and Syria and the results of the midterm elections.

  • Kaiser Health Tracking Poll: November 2014

    Feature

    Following the Nov. 4 midterm elections, nearly half of Americans expect increased debate between the two parties over the Affordable Care Act. In comparison, 42 percent say the amount of debate will not change, and very few (5%) say it will decrease. Conducted just prior to the start of the ACA's second open enrollment season, the poll also probes the views of people without health insurance, one of the key target groups for outreach and…