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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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  • How Will the Uninsured in South Dakota Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in South Dakota, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in South Dakota are eligible for Medicaid or financial…

  • How Will the Uninsured in Tennessee Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Tennessee, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Tennessee are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Wisconsin Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Wisconsin, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Wisconsin are eligible for Medicaid or financial assistance in…

  • Key Findings from the Field: Early Experience with ACA Enrollment in Maryland and Nevada

    Issue Brief

    To learn more about the early ACA enrollment experience in two states, the Kaiser Commission on Medicaid and the Uninsured and PerryUndem Research and Communication conducted focus groups in Baltimore, Maryland and Reno, Nevada in November 2013 with low- and moderate-income individuals who recently applied for health insurance and consumer assisters trained to help individuals enroll. This study builds on previous work that examined preparations for open enrollment in several states, including Maryland and Nevada,…

  • Medicaid Expansion in Red States

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman explains that Tennessee Gov. Bill Haslam's decision on Medicaid expansion via the Affordable Care Act is the latest sign of pragmatism slowly winning over ideology in red states.

  • Majority Favors the Affordable Care Act’s Employer Mandate, But Opinion Can Shift When Presented With Pros and Cons

    News Release

    Recent news stories on the heath law did not attract most Americans’ attention, and many are unaware of details and implications of the developments Weeks before the Affordable Care Act’s employer mandate takes effect in January, a new Kaiser Family Foundation tracking poll finds that six in 10 Americans (60%) say they have a favorable view of the provision, which in 2015 requires employers with 100 or more full time workers to offer health coverage…

  • Abortion Coverage in Marketplace Plans, 2015

    Issue Brief

    This brief analyzes state policies and insurer coverage decisions affecting the availability of abortion coverage in 2015 insurance plans offered through the Marketplaces. It finds that abortion coverage is unavailable in a total of 31 states, 24 of which have enacted laws that ban or restrict abortion coverage in plans sold through their Marketplaces and 7 of which have no abortion coverage restrictions but also have no Marketplace plans offering it.

  • The Cost of Care with Marketplace Coverage

    Issue Brief

    This brief and accompanying slides examine cost sharing - deductibles, copayments and coinsurance - in 2015 insurance plans sold on the Affordable Care Act's (ACA) federally-facilitated marketplaces. The analysis looks at out-of-pocket limits, as well as cost sharing for hospital stays, physician visits, emergency room visits, and prescription drugs, for plans across the metal levels (platinum, gold, silver and bronze).