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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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  • Navigator and In-Person Assistance Programs: A Snapshot of State Programs

    Issue Brief

    With the open enrollment period for health insurance exchanges less than six months away, consumers are already asking questions about their new health care options under the Affordable Care Act (ACA). Even in the age of digital information, hands-on consumer assistance could play a key role in helping people understand their insurance choices come 2014 — a recent Kaiser Family Foundation poll showed that two thirds of the uninsured and a majority of Americans overall…

  • Snapshots: Trends in Employer-Sponsored Health Insurance Offer Rates for Workers in Private Businesses

    Issue Brief

    Most Americans receive their health insurance through their own job or the job of a family member; an offer of coverage at work is an important determinant of the likelihood of having private health insurance. This analysis examines the percentage of nonelderly, full-time adult workers (age 18 through 64) in private firms who were offered health insurance at their current primary job and how that changed over the period from 1995 to 2005. The condition…

  • Snapshots: Comparison of Expenditures in Nongroup and Employer-Sponsored Insurance: 2004-2007

    Issue Brief

    Data from the insurance industry and reviews of premiums offered through on-line sellers show that premiums for nongroup health insurance are lower than premiums reported on national surveys for employer-sponsored health insurance (ESI).  This paper uses pooled data from the 2004 through 2007 Medical Expenditure Panel Survey to compare the insurance payments for and out-of-pocket payments by people with nongroup health insurance and people with ESI.  While premiums for non-group coverage are lower than ESI…

  • A Profile of Health Insurance Exchange Enrollees

    Report

    The Patient Protection and Affordable Care Act calls for the creation of Health Insurance Exchanges in all states by January 1, 2014. The exchanges are a critical element of the health reform law, aimed at helping individuals and families shop for and purchase health insurance on their own with additional assistance for lower-income individuals and families. The Congressional Budget Office has estimated that approximately 24 million people will purchase coverage through the state health exchanges…

  • Health Coverage by Race and Ethnicity: The Potential Impact of the Affordable Care Act

    Issue Brief

    Executive Summary One of the key goals of the Affordable Care Act (ACA) is to reduce the number of uninsured through a Medicaid expansion and the creation of health insurance exchange marketplaces with advance premium tax credits to help moderate-income individuals pay for this coverage. Given that people of color are at disproportionate risk of being uninsured and having low incomes, the ACA coverage expansions could particularly benefit communities of color and advance efforts to…

  • Quick Take: Key Considerations in Evaluating the ACA Medicaid Expansion for States

    Fact Sheet

    A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges.  Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have substantial consequences for health coverage for the low-income population. The 3 key questions that states should consider in…

  • Explaining Health Care Reform: Medical Loss Ratio (MLR)

    Fact Sheet

    This fact sheet explains the Medical Loss Ratio requirement under the Affordable Care Act (ACA). The MLR provision limits the portion of premium dollars health insurers may spend on administration, marketing, and profits. Under health care reform, health insurers must publicly report the portion of premium dollars spent on health care and quality improvement and other activities in each state they operate. Insurers failing to meet the applicable standard must pay rebates to consumers and…

  • ACA 101: What You Need to Know

    Event Date:
    Event

    Useful review for anyone seeking to comprehend complex issues leading up to major implementations taking effect in 2014

  • New Reports Find States Expecting 7.4 Percent Growth in Medicaid Spending In Fiscal Year 2011 As the Recession’s Lingering Effects Drive Up Enrollment

    News Release

    States Face New Budget and Workforce Challenges As Temporary Federal Aid Nears End And Health Reform Planning Heats Up WASHINGTON, D.C. – Due to the nation’s deep recession, states experienced rapid growth in their Medicaid enrollment and spending last year and expect additional growth, though at a slower pace, in fiscal year 2011, according to a survey of state Medicaid officials in all 50 states released today by the Kaiser Family Foundation’s Commission on Medicaid and…

  • Mapping the Effects of the ACA’s Health Insurance Coverage Expansions

    Interactive

    The Foundation originally released this interactive tool in February 2012.  More recent analysis of the Affordable Care Act's potential impact on each state's uninsured population can be accessed through this interactive tool and these individual state reports. The Affordable Care Act includes several provisions that allow many individuals across the U.S. to be eligible for Medicaid or for federal tax credits to subsidize the cost of insurance. The analysis below and zip code tool estimate…