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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 Is The Primary Care Safety Net Faring in Massachusetts? Community Health Centers In The Midst of Health Reform

    Report

    This report examines how community health centers, which provide comprehensive primary care for low-income and uninsured patients, have fared under Massachusetts' health reform law. Community health centers saw a significant increase in patient load amid the state's efforts to improve health coverage by expanding public programs and making private insurance more affordable. That experience shows that community health centers play a critical role in caring for newly insured patients while continuing to serve as the…

  • Health Insurance Market Reforms: Rate Restrictions

    Fact Sheet

    Rate restrictions limit how much insurance companies can vary premiums charged to individuals and businesses based on factors such as health status, age, tobacco use and gender. Currently, federal law does not place any limits on the ways that insurance companies set their premium rates. However, beginning January 1, 2014, insurance companies must meet the Affordable Care Act's minimum premium rating rules for health plans for individuals and small businesses. This brief explains the current…

  • Implementing the ACA’s Medicaid-Related Health Reform Provisions After the Supreme Court’s Decision

    Issue Brief

    On June 28, 2012, the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act (ACA). 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 by limiting the Health and Human Services (HHS) Secretary’s enforcement authority. The practical effect of the Court's decision makes the Medicaid expansion optional for states. This brief addresses questions…

  • Coverage of Preventive Services for Adults in Medicaid

    Issue Brief

    This brief highlights data from a survey of coverage of 42 recommended preventive services for adults in Medicaid fee-for-service programs as of October 2010. Medicaid programs must cover preventive services for children as part of the Early Periodic Screening, Diagnosis and Treatment (EPSDT) benefit, but generally are not required to cover such services for adults. The Affordable Care Act (ACA) provides states the opportunity to earn a one percentage point increase in their federal matching…

  • How Will Uninsured Children Be Affected By Health Reform?

    Issue Brief

    This brief examines uninsured children and how they could be affected by health reform, including estimates of how many might qualify for coverage under a Medicaid expansion, how many would be eligible for subsidies and how many would not be eligible for such help. Issue Brief (.pdf)

  • Pulling It Together: Predicting the Future

    Perspective

    A fair amount of attention was given recently to projections made by the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS) about the new health reform law, and how they compare to previous estimates by the Congressional Budget Office (CBO). No doubt the various projections will be grist for claims made in the upcoming political season, so it is important to be clear about the differences between the two estimates and to…

  • Pulling it Together: What Conservatives Are Winning

    Perspective

    Conservatives are out of sorts these days about the direction in which health care is headed. They think the new health reform law expands the role of government too much and spends too much at a time when they believe deficit reduction should be a higher priority. The claims about death panels and a government takeover of the health system aside, these are principled positions for conservatives to take – they are supposed to be…

  • Coping with Fragmented Payment in the Real World

    Event Date:
    Event

    The Alliance for Health Reform and The Commonwealth Fund sponsored this briefing which focused on three communities that have reformed and harmonized health care payments across payers to improve care: a New York health center that serves a low income population; a Colorado community that pools money from public and private sources to provide care for all patients; and the State of Maryland, which has been using an all payer hospital rate setting system for…

  • Patient Cost-Sharing Under the Affordable Care Act

    Report

    Under the Affordable Care Act (ACA), four tiers of health insurance will be offered in the health insurance exchanges and throughout the individual and small group markets beginning in 2014. Under the minimum coverage plan, the “Bronze” plan, the insurance plan will pay for 60 percent of the costs of covered benefits on average while the individual enrolled will pay the remaining 40 percent in deductibles, copays and coinsurance. Individuals will have the option to…

  • Health Care Reform Newsmaker Series: Sen. Orrin Hatch

    Event Date:
    Event

    This May 7, 2009 webcast features Sen. Orrin Hatch (R-Utah), senior member of the Senate Committee on Finance, and ranking Republican on the panel’s Subcommittee on Health Care. The briefing was part of the Health Care Reform Newsmaker series sponsored by the Kaiser Family Foundation, Families USA and the National Federation of Independent Business. The reporters-only briefings, designed to inform the public about prospects and options for health reform, feature a short presentation by an…