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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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  • Pulling it Together: An Actuarial Rorschach Test

    Perspective

    Drew Altman, Larry Levitt, Gary Claxton My colleagues have worked on this column with me and I invited them to join me as authors. As with pretty much every other discussion of health care going back to the days of Roosevelt, the great reform debate of 2009 (and now 2010) has been distilled into an ideological battle over the role of government. A government-sponsored "public option" has been off the table for a while now,…

  • Financial Incentives in the Long-Term Care Context: A First Look at Relevant Information

    Report

    Financial Incentives in the Long-Term Care Context: A First Look at Relevant Information This report reviews Medicare's payment policies as they may affect medical care for residents in long-term care environments, including a look at the financial incentives that could play a role in hospital and skilled nursing facility admissions. The report was prepared by Henry Desmarais at Health Policy Alternatives for the Foundation and released at an Oct. 12, 2010, policy briefing. Report (.pdf)

  • Pulling it Together: The “Third School” for Controlling Health Care Costs?

    Perspective

    For as long as I have been in the field, there have been two dominant schools of thought about how to control health care costs. One school, The Regulators, believed that the best way to slow increasing costs was to control the total resources going into the health care system: putting limits on the supply of medical professionals, technology and facilities; setting payment rates; or putting enough purchasing power in the hands of government to…

  • Holding Steady, Looking Ahead: Annual Findings Of A 50-State Survey Of Eligibility Rules, Enrollment and Renewal Procedures, And Cost Sharing Practices in Medicaid and CHIP, 2010-2011

    Report

    The annual 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost sharing practices, conducted by the Kaiser Commission on Medicaid and the Uninsured with the Georgetown University Center for Children and Families, found that, in 2010, coverage in Medicaid and the Children's Health Insurance Program remained strong with some improvements, particularly for low-income children. However, eligibility for their parents and other low-income adults continued to lag behind. The survey also…

  • Key Findings: Kaiser Health Tracking Poll — August 2009

    Poll Finding

    This document contains the key findings from the August Health Tracking Poll. The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted August 4 through August 11, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (801) and cell phone (402, including 123 who had no landline telephone) were carried out in English and Spanish. The margin…

  • To Hospitalize or Not to Hospitalize? Medical Care for Long-Term Care Facility Residents

    Report

    To Hospitalize or Not to Hospitalize? Medical Care for Long-Term Care Facility Residents This report explores factors that appear to drive relatively high rates of hospitalizations, based on interviews with doctors, nursing home staff and families in four cities. Key factors include liability concerns, limited onsite staff capabilities, difficulty reaching residents' physicians for care instructions on nights and weekends, better and more timely access to diagnostic tests in hospitals, and patient preferences. Physicians with patients…

  • Community Health Centers: Can They Plug the Gaps in the Safety Net?

    Event Date:
    Event

    The Alliance for Health Reform and the Centene Corporation sponsored a July 23 briefing to discuss the role of community health centers (CHCs) in providing care to vulnerable populations as employer-sponsored coverage declines and demand for safety-net services increase. Panelists addressed questions such as: How are states and safety-net systems planning for 2014 and the challenges and opportunities presented under the ACA? Is there sufficient federal oversight of their operations? For more information, please visit…

  • Private Insurers Expect to Pay $1 Billion in Rebates to Consumers This Year for Setting Premiums Too High Relative to Medical Costs

    News Release

    Private insurance companies are expecting to pay out $1 billion in rebates to consumers this fall under an Affordable Care Act provision that requires insurers to spend the bulk of customers’ premium payments on care, a new KFF analysis finds. Rebates are based on insurers’ experiences over the previous three years. This year’s total is roughly half the size of last year’s $2 billion, in part because 2021 was a less profitable year and because…

  • ¿Me pueden cobrar primas más altas en el mercado si fumo? ¿Cuentan los cigarrillos electrónicos?

    FAQs

    En la mayoría de los estados, sí. Generalmente, una aseguradora puede cobrarle hasta un 50% más si ha consumido productos de tabaco cuatro o más veces por semana en promedio durante los últimos 6 meses. Esto se denomina recargo por tabaco. Por ejemplo, si la prima para alguien de su edad (antes de aplicar los subsidios) fuera de $200 al mes, si usted consume tabaco, su prima podría aumentar a $300 al mes. Las normas…

  • Poll: Most Americans Say President Trump is Intervening with the FDA’s and CDC’s Coronavirus Work, But Trust the Agencies at Least a Fair Amount to Do the Right Thing

    News Release

    As COVID-19 cases rise across much of the country, most Americans think that the president is intervening with the public health agencies working to address the pandemic, the latest KFF Health Tracking Poll finds. Similar majorities say both that President Trump is intervening with the Food and Drug Administration’s efforts to review and approve a coronavirus vaccine (55%) and that he is in intervening with the Centers for Disease Control and Prevention’s efforts to issue coronavirus guidelines…