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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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  • Poll: 1 in 3 ACA Marketplace Enrollees Say They Would “Very Likely” Shop for a Cheaper Plan If Their Premium Payments Doubled; 1 in 4 Say They “Very Likely” Would Go Without Insurance

    News Release

    If the amount they pay in premiums doubled, about one in three enrollees in Affordable Care Act Marketplace health plans say they would be “very likely” to look for a lower-premium Marketplace plan (with higher deductibles and co-pays) and one in four would “very likely” go without insurance next year, finds a new survey of Marketplace enrollees fielded shortly after open enrollment began in the first weeks of November. The survey captures the views and…

  • 2025 KFF Marketplace Enrollees Survey

    Poll Finding

    This survey explores how ACA Marketplace enrollees expect to respond if their premium payments doubled as expected in 2026 when enhanced premium tax credits are set to expire. About a third would very likely look for a lower-cost plan, even if it had higher deductibles, and about a quarter would very likely end up uninsured. The survey also examines how increased health care costs may affect their finances and the potential impact in next year's…

  • Mapping the Uneven Burden of Rising ACA Marketplace Premium Payments due to Enhanced Tax Credit Expiration

    Issue Brief

    Enhanced premium tax credits expire at the end of this year. Among those with incomes over 400% poverty who are losing the tax credit altogether, the impact will be greatest for those whose unsubsidized premiums are highest: older Marketplace enrollees and those living in higher-premium locales. The maps in this brief show how much average premium payments would increase for 2026 benchmark silver plans with the expiration of enhanced premium tax credits at three income…

  • The New ACA Repeal and Replace: Health Savings Accounts

    Policy Watch

    Proposals from some Republicans in Congress would effectively repeal some or all of the ACA premium tax credits and replace them with contributions to Health Savings Accounts (HSAs) or something similar. Senator Rick Scott proposes “Trump Health Freedom Accounts” and Senator Bill Cassidy proposes HSA contributions available only for people who enroll in bronze level ACA plans to pay for out-of-pocket health care costs.

  • Deductibles in ACA Marketplace Plans, 2014-2026

    Fact Sheet

    This analysis documents average deductibles for Affordable Care Act Marketplace plans available on Healthcare.gov in 2026 for all metal tiers, including silver plans after cost-sharing reductions are applied, as well as trend data since 2014.

  • Poll: Support for Extending the Expiring Enhanced ACA Tax Credits Remains High, But Dips Among Republicans and MAGA Supporters as Shutdown Continues and Partisanship Takes Hold

    News Release

    As the government shutdown continues, public support remains high for extending the enhanced ACA tax credits set to expire at the end of the year, with three quarters (74%) of the public in favor of extending them, a new KFF Health Tracking Poll finds. The expiring tax credits are a central issue in the ongoing Congressional budget standoff, as Democrats want the tax credits extended as part of a budget deal while Republicans want to…

  • KFF Health Tracking Poll: Public Weighs in on Health Care Debate and Government Shutdown 

    Poll Finding

    This poll finds that public support remains high for extending the enhanced ACA tax credits set to expire at the end of the year. Three quarters of the public favor of extending them, though support among Republicans has dipped since September. Most Democrats want a Congressional budget deal to include an extension of the tax credits.

  • How ACA Marketplace Costs Compare to Employer-Sponsored Health Insurance

    Issue Brief

    This analysis compares ACA Marketplace costs to employer-sponsored health insurance costs and finds that individual market premiums have become more similar to employer-sponsored premiums over time. In 2024, individual market insurance premiums averaged $540 per member per month, slightly below the average $587 per member per month premium for fully-insured employer coverage. The analysis uses data from Mark Farrah Associates Health Coverage Portal to compare average premiums in the individual and group insurance markets. The…