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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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  • Kaiser Health Tracking Poll — November 2011

    Feature

    The November Health Tracking Poll takes a closer look at public opinion and knowledge about specific provisions of the Patient Protection and Affordable Care Act (ACA). Findings include: After taking a negative turn in October, the public's overall views on the ACA returned to a more mixed status this month. Still, Americans remain somewhat more likely to have an unfavorable view of the law (44%) than a favorable one (37%). The survey also finds that…

  • Financial Alignment Models for Dual Eligibles: An Update

    Issue Brief

    The nearly nine million dual eligibles who receive both Medicare and Medicaid benefits are a high cost, high need population, accounting for a disproportionate share of expenditures relative to their enrollment in both programs. In April 2011, the Centers for Medicare and Medicaid Services (CMS) announced the award of design contracts to 15 states to develop service delivery and payment models to integrate care for dual eligibles. CMS and the participating states have recognized that…

  • Kaiser Health Tracking Poll: Support for Health Reform Law Dips in October

    Perspective

    After remaining roughly evenly split for most of the last year and a half, this month’s tracking poll found a higher share of the public expressing negative views towards the health reform law. About half (51 percent) say they have an unfavorable view of the Patient Protection and Affordable Care Act (ACA), while 34 percent have a favorable view, a low point in Kaiser polls since the law was passed. While Democrats continue to be substantially…

  • Questions About Essential Health Benefits

    Perspective

    The Institute of Medicine (IOM) recently issued its long-awaited report on defining the essential health benefits under the Affordable Care Act (ACA). As expected, the committee preparing the IOM report did not recommend which specific services should be covered, but rather discussed what the process should be for defining the essential benefits, which all insurers selling coverage to individuals and small businesses will have to provide beginning in 2014. Somewhat unexpected was their recommendation to set a…

  • State Exchange Profiles: Kansas

    Other Post

    Final update made on March 21, 2013 (no further updates will be made) Establishing the Exchange After placing health insurance exchange planning on hold until after the November elections, Governor Sam Brownback (R) announced on November 9, 2012, Kansas would default to a federally-facilitated exchange.1,2 With the initial endorsement of the Governor in 2011, Kansas Insurance Commissioner Sandy Praeger, had established eight exchange planning work groups comprised of hundreds of volunteers across civic groups, government…

  • State Marketplace Profiles: Hawaii

    Other Post

    Final update made on November 6, 2013 (no further updates will be made)  Establishing the Marketplace On July 11, 2011, Governor Neil Abercrombie (D) signed SB 1348 into law establishing the Hawaii Health Connector, a State-based health insurance Marketplace.1  The law builds on Hawaii’s Prepaid Health Care Act of 1975 (PHCA) which required nearly all employers to provide health insurance to employees working 20 or more hours a week for four consecutive weeks.2  Structure: The legislation established the…

  • State Exchange Profiles: Maine

    Other Post

    Final update made on April 2, 2013 (no further updates will be made)  Establishing the Exchange On November 16, 2012, Governor Paul LePage (R) wrote in a letter to federal officials that Maine would not be pursuing efforts to implement a state-based health insurance exchange.1 Legislation establishing a state-run health insurance exchange failed to pass in 2011 and 2012. Prior to ending planning efforts, the Governor created an exchange Advisory Committee in July 2011, which included…

  • State Exchange Profiles: New Jersey

    Other Post

    Final update made on December 10, 2012 (no further updates will be made) Establishing the Exchange  On December 7, 2012, Governor Chris Christie (R) vetoed A 3186/S 2135, which would have established a health insurance exchange within the Department of Banking and Insurance and announced that the state would default to a federal exchange.1Governor Chris Christie (R) vetoed similar legislation earlier in 2012.2 In 2011, the New Jersey Interagency Working Group on the ACA, led…

  • State Exchange Profiles: Texas

    Other Post

    Final update made on December 11, 2012 (no further updates will be made) Establishing the Exchange On July 9, 2012, Governor Rick Perry (R) announced that Texas would not establish an exchange.1 Prior to this announcement, the Department of Insurance and the Health and Human Services Commission had partnered to explore exchange implementation plans.2 Using federal grant funding they identified subcontractors to assist with the exchange planning process, to collect stakeholder feedback, and to investigate the state’s…

  • State Marketplace Profiles: Rhode Island

    Other Post

    Final update made on October 8, 2013 (no further updates will be made)  Establishing the Marketplace After the legislature failed to pass Marketplace legislation during the 2011 session, Governor Lincoln Chafee (I) signed Executive Order 11-09 on September 19, 2011, to establish the Rhode Island Health Benefit Exchange.1  In July 2013, Rhode Island announced that its Marketplace would be called HealthSource RI.2  Recommendations by the Rhode Island Healthcare Reform Commission largely informed the Governor’s decision to…