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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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  • Medicaid Coverage of Pregnancy and Perinatal Benefits: Results from a State Survey

    Report

    This report details findings from a state survey on perinatal benefits in place as of July 1, 2015 for women enrolled in fee-for-service Medicaid through different eligibility pathways, including traditional pre-ACA Medicaid pathways, expansion, and pregnancy-related eligibility for the following services: basic prenatal care, counseling and support services, delivery and postpartum care, and breastfeeding supports.

  • State Variation in Medicaid Per Enrollee Spending for Seniors and People with Disabilities

    Issue Brief

    This issue brief explains the variation in Medicaid spending per enrollee for seniors, nonelderly adults with disabilities, and children with disabilities compared to other populations as well as the variation in per enrollee spending for these populations among states. It also provides a snapshot of state choices about optional eligibility pathways and services important to many seniors and people with disabilities.

  • Proposed Medicaid Section 1115 Waivers in Maine and Wisconsin

    Issue Brief

    While the future of legislation to repeal and replace the Affordable Care Act (ACA) and make fundamental changes to the structure and funding of the Medicaid program is uncertain, states and the Administration may achieve major changes to Medicaid through the use of Section 1115 Medicaid waivers. Wisconsin submitted a waiver amendment request to CMS in June 2017 and Maine submitted a waiver application to CMS in August 2017. Unlike previous waivers that encompass the…

  • Marketplace Insurers Denied Nearly 1 in 5 In-Network Claims in 2020, though It’s Often Not Clear Why

    News Release

    Healthcare.gov marketplace insurers denied nearly one out of every five claims (18%) submitted for in-network services in 2020, though why the denial rates are so high and the ultimate consequences for consumers are difficult to access from the publicly available data, a new KFF analysis finds. The Affordable Care Act requires insurers to report data about claims denials and appeals to encourage transparency about how insurance coverage works for enrollees. The analysis examines data released…

  • Firearms are the Leading Cause of Death for Children in the United States But Rank No Higher Than Fifth in Other Industrialized Nations

    News Release

    Firearms are now the number one cause of death for children in the United States, but rank no higher than fifth in 11 other large and wealthy countries, a new KFF analysis finds. Guns - including accidental deaths, suicides, and homicides - killed 4,357 children (ages 1-19 years old) in the United States in 2020, or roughly 5.6 per 100,000 children. In each of the peer countries, guns kill fewer children than motor vehicles, cancer,…

  • Marketplace Insurers are Proposing a 6% Average Premium Hike for 2024 and Pointing to Inflation as a Key Driver of Costs

    News Release

    ACA Marketplace insurers are requesting a median premium increase of 6% for 2024, according to a new KFF analysis of the preliminary rate filings. Insurers’ proposed rate changes – most of which fall between 2% and 10% – may change during the review process. Although most Marketplace enrollees receive subsidies and are not expected to face these added costs, premium increases could result in higher federal spending on subsidies. Insurers cite price increases for medical…

  • ACA’s Maximum Out-of-Pocket Limit Is Growing Faster Than Wages

    Issue Brief

    This analysis finds that the ACA’s maximum out-of-pocket limit is likely to grow faster than wages and salaries, and is also expected to grow faster than the maximum out-of-pocket limit for Health Savings Account (HSA)-qualified health plans.

  • Five Things to Know about the Renewal of Extra Affordable Care Act Subsidies in the Inflation Reduction Act

    Policy Watch

    As part of the Inflation Reduction Act, the Senate recently passed a three-year extension (through 2025) of enhanced subsidies for people buying their own health coverage on the Affordable Care Act Marketplaces. The enhanced subsidies increase the amount of financial help available to those already eligible and also newly expand subsidies to middle-income people, many of whom were previously priced out of coverage. Here’s what to know about the likely renewal of these subsidies:

  • The Biggest Health Care Reform in a Decade Could Lower Your Costs

    Perspective

    Larry Levitt writes about the political and practical impact of the health care provisions in the Inflation Reduction Act  in The New York Times guest essay, “The Biggest Health Care Reform in a Decade Could Lower Your Costs.”