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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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  • State Marketplace Profiles: Maryland

    Other Post

    Final update made on November 13, 2013 (no further updates will be made)  Establishing the Marketplace On April 12, 2011, Governor Martin O’Malley (D) signed SB 182/HB 166 into law establishing the Maryland Health Benefit Exchange (MBHE).1   In May of the following year, Governor O’Malley signed additional Marketplace legislation (SB 372/HB 433) which addressed multiple Marketplace implementation and operational issues and was based on recommendations by the Board of Directors and advisory groups from 2011.2 …

  • State Marketplace Profiles: Connecticut

    Other Post

    Final update made on September 27, 2013 (no further updates will be made)  Establishing the Marketplace On July 1, 2011, Governor Dan Malloy (D) signed SB921 (Public Act 11-53) into law establishing the Connecticut Health Insurance Exchange.1   Legislation altering the composition of the Exchange Board passed in June 2012.2 3  In December 2012, the Exchange announced that its new name would be “Access Health CT.” Structure: The legislation defines Connecticut’s Health Insurance Exchange as a quasi-governmental organization, specifically "a…

  • State Exchange Profiles: Florida

    Other Post

    Final update made on December 14, 2012 (no further updates will be made) Establishing the Exchange In December 2012, Governor Rick Scott (R) announced that Florida would not be pursuing efforts to implement a state-based health insurance exchange.1 Governor Scott has been a vocal opponent of federal health reform and the state has refused multiple funding opportunities available through the Affordable Care Act (ACA).2 Florida was also the lead plaintiff in a lawsuit brought by 26 states…

  • Explaining Health Reform: How will the Affordable Care Act affect Small Businesses and their Employees?

    Fact Sheet

    Several provisions of the Affordable Care Act (ACA) will likely have significant effects on small businesses, their employees, and families. Currently, smaller businesses are less likely to offer health insurance coverage to their employees than larger companies: 57% of small businesses with 50 or fewer workers offered health benefits to employees, compared to 92% of businesses with 51 to 100 workers, and 97% of businesses with 101 or more workers in 2011.1  This fact sheet explains…

  • Access to Adult Dental Care Gets Renewed Focus in ACA Marketplace Proposal

    Policy Watch

    Adult dental care can lead to high out of pocket costs for consumers, especially for those with private insurance coverage. This post analyzes a proposed provision in the HHS Notice of Benefit and Payment Parameters for 2025, and possible implications for consumers who have Marketplace coverage.

  • The Numbers Behind “Young Invincibles” and the Affordable Care Act

    Perspective

    As enrollment statistics in the new health insurance marketplaces start to become available, there is a growing focus on whether the enrollment of so-called “young invincibles” will be sufficient to keep insurance markets stable. Enrollment of young adults is important, but not as important as conventional wisdom suggests since premiums are still permitted to vary substantially by age. Because of this, a premium “death spiral” is highly unlikely. Why does the age distribution of enrollees…

  • Kaiser Health Tracking Poll: May 2014

    Feature

    More than four years after the Affordable Care Act's enactment and more than a month after the close of open enrollment, six in 10 Americans say the health reform law has not had an impact on them or their families, Kaiser’s May Tracking Poll finds. Among those who say it has, Republicans are much more likely to say their families have been hurt by the law than helped, while Democrats are more likely to say…

  • The Washington State Health Care Landscape

    Fact Sheet

    This fact sheet provides an overview of population health, health coverage, and health care delivery in Washington under the Affordable Care Act (ACA).

  • On Medicaid Expansion, Red States Will Be Watching Red States

    From Drew Altman

    This was published as a Wall Street Journal Think Tank column on June 30, 2014. Since the Supreme Court made expanding Medicaid optional for states under the Affordable Care Act, 26 states have expanded Medicaid. Three of the 24 states that have not–Indiana, Utah and Pennsylvania–are considering expanding via federal waivers that they are negotiating with the Obama administration. In Virginia, the newly elected Democratic governor is looking for a way around opposition from the Republican-controlled legislature,…