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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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  • The ACA is Doing Fine Without a Mandate Penalty

    From Drew Altman

    In an Axios column, Drew Altman explains that the elimination of the Affordable Care Act’s individual mandate penalty has had little impact on how the ACA’s insurance markets are working, showing that “the marketplaces continue to function, even when 'severed' from the mandate penalty,” and undercutting a central argument in the lawsuit seeking to strike down the entire law.

  • Health Policy in 2020 Will Be Made in the States

    From Drew Altman

    With a questionable outlook for 2020 passage of legislation on prescription drug pricing and surprise medical bills, Drew Altman says the real action to watch in health policy is likely to be in the states.

  • 10 Key Questions on Public Option Proposals

    Issue Brief

    This issue brief presents ten, high-level key questions regarding current public option proposals supported by both Democratic presidential candidates and Members of Congress.

  • Private Insurance’s Costs are Skyrocketing

    From Drew Altman

    In this Axios column, Drew Altman takes a long-term view of the recently released federal data on health spending showing that spending for private insurance is rising much faster than for Medicare and Medicaid, and predicts rising pressure in the health care industry as a result. 

  • Analysis: 4.7 Million Uninsured People Nationally Could Get a No-Premium Bronze Plan in the ACA Marketplace,Though Deductibles Would be High

    News Release

    As the Affordable Care Act’s open enrollment period nears an end in most areas this week, a new KFF analysis finds that 4.7 million currently uninsured people could get a bronze-level plan for 2020 and pay nothing in premiums after factoring in tax credits, though the deductibles would be high. That works out to 28 percent of the 16.7 million uninsured individuals who are potential customers for coverage through ACA marketplaces. Half of the uninsured…

  • How Many of the Uninsured Can Purchase a Marketplace Plan for Free in 2020?

    Issue Brief

    This analysis looks at how many of the remaining uninsured are eligible for premium subsidies that are large enough to cover the entire cost of a bronze plan, which is the minimum level of coverage available on the Marketplaces. It estimates 28% of uninsured individuals who could shop on the ACA Marketplace, or 4.7 million people nationwide, are eligible to purchase a bronze plan with $0 premiums after subsidies in 2020.

  • Surprise Bills Often Hit in Emergencies

    From Drew Altman

    In an Axios column, Drew Altman previews new data highlighting that people with critical health issues are especially vulnerable to these bills.