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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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  • Affordability and Health Reform: If We Mandate, Will They (and Can They) Pay?

    Event Date:
    Event

    The Alliance for Health Reform and The Commonwealth Fund co-sponsored this briefing to explore the health reform proposals being considered which may impose responsibilities on both individuals and employers to have and help pay for coverage and whether they will be able to pay the amounts above the subsidies. Questions addressed include:If Congress exempts people from the coverage requirement or significantly reduces the penalties for noncompliance, will enough healthy individuals purchase new coverage to adequately…

  • Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

    Issue Brief

    Massachusetts is the first state to finalize a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test CMS's capitated financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, with enrollment beginning on April 1, 2013. Starting in 2013, CMS will implement a three-year multi-state demonstration to test new service delivery and payment models for people who are eligible for both federal health programs. Massachusetts' demonstration…

  • The Right Care at the Right Time: Are Retail Clinics Meeting a Need?

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    Event

    The Alliance for Health Reform and WellPoint, Inc. discuss the role of urgent care centers and retail clinics emerging within the health care system. Panelists will explore such questions as: Can savings and improved access to care be produced through alternative care settings? Will these settings reduce emergency room use for primary care? Do they have the potential to ease the shortage of primary care providers? Who is monitoring the quality of care being delivered…

  • Coverage of Colonoscopies Under the Affordable Care Act’s Prevention Benefit

    Report

    The Affordable Care Act (ACA) requires private health insurers to cover recommended preventive services such as colonoscopies without any patient cost-sharing. This report finds that confusion over whether colon cancer screenings are preventive care or treatment means patients sometimes receive unexpected bills for the procedure. The report examines cost-sharing practices for colorectal screenings through interviews with experts and officials in the medical and insurance industries. This report was co-authored by The Kaiser Family Foundation, American…

  • Children and Oral Health: Assessing Needs, Coverage and Access

    Issue Brief

    This policy brief highlights the prevalence of dental problems among children and examines gaps in oral health coverage and access to dental care, as well as disparities by income and race/ethnicity. It also looks at out-of-pocket costs for dental care, explains the role of Medicaid and CHIP in dental care, coverage and access for children and describes the expansion of oral health coverage for children under the Affordable Care Act. Issue Brief (.pdf)

  • Short-Term Health Insurance Plans Charge Less than Half as Much in Premiums as ACA Plans By Excluding Pre-Existing Conditions and Severely Limiting Benefits

    News Release

    Short-term health insurance plans offer a trade-off for consumers: substantially lower premiums than plans that comply with the Affordable Care Act, but much less protection if they get sick and need care. Just how much cheaper are the premiums and what are consumers giving up to get them? A new KFF (Kaiser Family Foundation) analysis finds short-term plans are able to charge premiums 54 percent lower than ACA-compliant plans, by excluding pre-existing conditions and severely…

  • What Does the Outcome of the Midterm Elections Mean for Medicaid Expansion?

    Fact Sheet

    While not typically an election issue, Medicaid — particularly the Medicaid expansion created under the Affordable Care Act (ACA) — was an important issue in the 2018 midterm elections in a number of campaigns throughout the country. This fact sheet highlights key states in which the results of the 2018 midterm elections have implications for Medicaid adoption or implementation. States examined include those that had Medicaid expansion ballot initiatives as well as states that have…

  • More Insurers Are Participating in the ACA Marketplaces in 2019

    News Release

    Insurer participation in the Affordable Care Act’s health insurance marketplaces is rising in 2019, finds a new analysis from KFF (the Kaiser Family Foundation).The increase follows consecutive years of improving insurance company profits and shows up in several different ways: Going into 2019, 608 counties nationwide are gaining at least one insurer in the marketplace, while only five counties will lose an insurer. In 2019, roughly 17 percent of enrollees (living in 37 percent of…

  • Some Can Get Marketplace Plans With No Premiums,Though With Higher Deductibles and Cost-Sharing

    News Release

    Many low-income consumers who are eligible for federal financial help under the Affordable Care Act can get a bronze-level plan and pay nothing out-of-pocket in premiums in more than 2,000 counties next year, depending on their annual income, according to a new analysis from KFF (the Kaiser Family Foundation). Such plans come with higher deductibles and out-of-pocket maximums, however. The analysis finds that the ACA’s premium tax credits would cover the full premium of the lowest-cost bronze…