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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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  • Key Issues in Children’s Health Coverage

    Issue Brief

    This brief reviews children’s coverage today and examines what is at stake for children’s coverage in upcoming debates around CHIP funding, repeal and replacement of the ACA, and Medicaid restructuring.

  • Insurance Coverage Changes for People with HIV Under the ACA

    Issue Brief

    This brief provides the first national estimates of changes in insurance coverage among people with HIV since the implementation of the ACA. We find that coverage increased significantly for people with HIV due to the ACA’s Medicaid expansion; indeed, increased Medicaid coverage in expansion states drove a nationwide increase in coverage for people with HIV.

  • Data Note: Effect of State Decisions on State Risk Scores

    Issue Brief

    To gauge whether individual market risk pools are healthier in states that have expanded Medicaid and did not allow transitional plans, this data note compares average state risk scores using data from the Centers for Medicare & Medicaid Services Summary Report on Risk Adjustment for the 2015 benefit year. The analysis finds that states that expanded Medicaid and did not allow transitional plans had lower average risk scores, suggesting the risk pools in those state’s…

  • 50-State Survey Finds Slower Growth in Total Medicaid Spending Nationally in FY 2016 and Projected for FY 2017 as Earlier Increases from the Affordable Care Act’s Coverage Expansions Taper Off

    News Release

    After record increases in fiscal year 2015, growth in Medicaid enrollment and total Medicaid spending nationally slowed substantially in FY 2016 and are projected to continue to slow in FY 2017 as the initial surge of enrollment under the Affordable Care Act’s coverage expansions tapered off, according to the 16th annual 50-state Medicaid Budget Survey by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.  Despite recent trends, Medicaid officials identified high cost and specialty drugs…

  • The Affordable Care Act’s Little-Noticed Success: Cutting the Uninsured Rate

    From Drew Altman

    This column was published as a Wall Street Journal Think Tank column on October 12, 2016. U.S. Uninsured Rate is At An All-Time Low, But The Public Doesn’t Know It Donald Trump derided the Affordable Care Act in the second presidential debate as a “total disaster.” One inarguable success of the 2010 health-care law has been to drive the rate of uninsured Americans to a historic low. That sizeable shift makes it significant that a plurality of the…

  • Analysis: Nearly 12 Million People Who Remain Uninsured Are Eligible for Financial Help Under the Affordable Care Act, About Half Through Medicaid and Half Through the Marketplaces

    News Release

    As the Nov. 1 start of the Affordable Care Act’s fourth open enrollment period approaches, a new Kaiser Family Foundation analysis estimates that 11.7 million people who remain without health insurance are eligible for Medicaid in their state or for tax credits to purchase health insurance through their state’s Affordable Care Act marketplace. While millions of people have gained coverage under the ACA and the nation’s uninsured rate has fallen to a record low, the…

  • Where President-elect Donald Trump Stands on Six Health Care Issues

    Issue Brief

    Where does President-elect Donald Trump stand on key health care issues? This snapshot outlines his positions and policy statements during the campaign on issues such as health insurance, the ACA, Medicaid, Medicare, the opioid epidemic, prescription drug costs, and women's reproductive health.