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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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  • About 1 in 6 Emergency Visits and Hospital Stays Had At Least One Out-of-Network Charge in 2017

    News Release

    In roughly 1 of every 6 emergency room visits and inpatient hospital stays in 2017, patients came home with at least one out-of-network medical bill, a new KFF analysis finds. More specifically, 18 percent of all emergency visits and 16 percent of in-network hospital stays had at least one out-of-network charge, leaving patients at risk for surprise medical bills, according to the analysis of claims data from large employer plans. The analysis also finds the…

  • Universal Coverage May Not Mean Everyone Has Health Insurance

    From Drew Altman

    Universal coverage is a big and important goal. But would absolutely everyone be covered under current proposals? Is it a better rallying cry for Democrats in the primaries or the general election? Drew Altman analyzes these questions in an Axios column.

  • KFF Health Tracking Poll – June 2019: Health Care in the Democratic Primary and Medicare-for-all

    Feature

    In anticipation of upcoming Democratic presidential debates, this poll finds that Democrats and Democratic-leaning independents say that health care is a top issue they want to hear candidates talk about. When asked to say in their own words what health care issue they specifically want to hear about, affordability emerges as one of the top issues. The poll also probes the public about different possible implications of implementing a Medicare-for-all plan and finds that most…

  • Poll: Most Americans Don’t Realize How Dramatically the Medicare-for-all Proposals Would Revamp the Nation’s Health Care System

    News Release

    As Congress and the Democratic presidential candidates continue to discuss Medicare-for-all and other proposals to expand public health coverage, most Americans know little about how the leading Medicare-for-all proposals would reshape the way all Americans get and pay for health care. This month’s KFF Health Tracking Poll probes the public’s awareness of key elements of proposals to create a national health plan, including the leading Medicare-for-all bills introduced by Sen. Bernie Sanders and Rep. Pramila…

  • Visualizing Health Policy: Barriers to Care Experienced by Women in the United States 

    News Release

    This Visualizing Health Policy infographic looks at barriers to care experienced by women in the United States. Women incur greater health care costs than men, particularly during the reproductive years. Despite a lower uninsured rate than men (11% vs 14%), women are more likely to skip a recommended medical test or treatment due to cost. However, cost barriers to contraception have decreased for insured women since the Affordable Care Act’s (ACA’s) coverage requirement took effect.…

  • Voters Are Tuning Out the Health Care Debates

    From Drew Altman

    In this Axios column, Drew Altman reports on new KFF focus groups with voters. They show voters are focused on the problems they have paying for care and navigating the health system, but have yet to tune in on the health proposals being made by candidates and elected officials, and don’t see them as relevant to their problems. 

  • JAMA Forum: Medicare-For-All or Medicare-For-More?

    Perspective

    In this May 2019 post for The JAMA forum, Larry Levitt examines how the early discussion and positioning among the presidential candidates offers a glimpse into how a debate about Medicare-for-all might play out.