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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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  • Pulling It Together: The Repeal Trap?

    Perspective

    Almost a year into an often acrimonious health reform debate, we stand poised for near certain passage of historic health reform legislation. Yet, somewhat perplexingly, there's now talk about whether a law that has not even been enacted might actually be repealed and reporters have been calling asking what the chances of repeal may be. I have a very hard time imagining any scenario for repeal unfolding. Calls for repeal have much to do with…

  • Optimizing Medicaid Enrollment: Perspectives on Strengthening Medicaid’s Reach Under Health Care Reform

    Issue Brief

    The health reform law creates a national plan for near-universal health coverage that relies on a large expansion of Medicaid eligibility as its foundation. This brief draws on recent interviews with Medicaid program directors and other experts about the opportunities that health reform presents to optimize Medicaid by strengthening its enrollment and renewal operations and recasting it as an affordable health coverage program for working people and families. Executive Summary (.pdf) Issue Brief (.pdf)

  • The Independent Payment Advisory Board: A New Approach to Controlling Medicare Spending

    Issue Brief

    In 2010, the Patient Protection and Affordable Care Act authorized the creation of the Independent Payment Advisory Board (IPAB) to help control the growth in Medicare costs. Beginning in 2014, IPAB will issue recommendations to lower Medicare costs in the event that spending exceeds targets established in the health care reform law. This brief explains how the Independent Payment Advisory Board will be structured, the process and timelines for IPAB to make recommendations to achieve…

  • Medicaid Policy Options for Meeting the Needs of Adults with Mental Illness under the Affordable Care Act

    Issue Brief

    This paper examines the salient issues raised in a November 2010 roundtable discussion of national and state experts convened by the Kaiser Commission on Medicaid and the Uninsured, in partnership with the Bazelon Center for Mental Health Law, to discuss Medicaid policy options available under health reform to help meet the needs of adults with mental illness. The Patient Protection and Affordable Care Act will expand the Medicaid program, offering the opportunity to improve access…

  • Pulling It Together: Rising Health Costs Are Not Just a Federal Budget Problem

    Perspective

    Premiums for employer-provided health insurance, where 150 million Americans get their coverage, jumped 9% in 2011 while workers’ wages grew just 2%, according to our annual employer survey.  The average family policy now costs more than $15,000 per year, more than the cost of a Chevy Aveo or a Ford Fiesta.  Since we began doing this survey thirteen years ago, worker contributions to premiums have increased 168%, wages 50%, and inflation 38%. Critics of the…

  • Small Area Variations and the ACA’s Coverage Expansions

    From Drew Altman

    A new Kaiser analysis sheds light on how the country might react to the Affordable Care Act (ACA) when it is implemented.  It looks at how the benefits of the ACA's coverage expansions will vary around the country by census areas (technically, Public Use Microdata Areas, or PUMAs).  PUMAs are artificial areas of about 100,000 people each created by the Census Bureau to provide more detailed demographic, social and economic information at the local level.  They…

  • A Guide to the Supreme Court’s Decision on the ACA’s Medicaid Expansion

    Issue Brief

    On June 28, 2012, the U.S. Supreme Court issued its decision in the case challenging the Affordable Care Act (ACA). The Court upheld the constitutionality of the ACA's individual mandate, which requires most people to maintain a minimum level of health insurance coverage beginning in 2014. A majority of the Court also found the ACA's Medicaid expansion unconstitutionally coercive of states, while a different majority of the Court held that this issue was fully remedied…

  • Kaiser Health Tracking Poll: Election 2008 — April 2008

    Poll Finding

    An April 2008 poll finds that health care costs rank among Americans’ top personal economic problems, and their struggles to deal with those costs have affected both their financial well-being and their family’s health care.  Conducted by the Foundation’s public opinion researchers, the poll probes into the economic concerns facing Americans and the ways they have dealt with the cost of health care. Across a series of economic concerns, health care costs rank near the…

  • Kaiser Health Tracking Poll: Election 2008 – June 2008

    Poll Finding

    The latest Kaiser Health Tracking Poll: Election 2008 poll finds that the recent economic downturn continues to create serious financial problems for most Americans. When asked about the impact of recent economic changes, nearly six in 10 adults (59 percent) report having a "serious problem" with one of seven major financial issues, including one in four who cite paying for health care as a serious problem. Not surprisingly, with gas prices topping $4 per gallon…

  • Medicaid as a Platform for Broader Health Reform: Supporting High-Need and Low-Income Populations

    Issue Brief

    Medicaid is the health insurance safety net for nearly 60 million of the nation's poorest and sickest individuals. It provides access to a comprehensive scope of benefits with limited cost-sharing that is geared to meet the health needs and limited resources of the low-income, high-need populations it serves, populations for whom private coverage is often not available, not affordable or inadequate. This paper, based on years of research and analysis from the Kaiser Commission on…