Health Costs

Affordability and Spending

Our Darwinian Approach to Health Care Costs

Our Darwinian Approach to Health Care Costs

In his latest column, President and CEO Dr. Drew Altman presents his Venn diagram of health care cost problems and shows how, in our fragmented health system, reducing one health cost problem often makes another worse. "...Reducing health care costs has become a Darwinian game; everyone wants to reduce health care costs and spending – their own, often at the expense of someone else."

Affordable Care Act

An image of text is an excerpt form Jared Ortaliza's quick take which reads, "Data currently being released represent Open Enrollment ACA Marketplace plan selections, or how many people have signed up for or been automatically renewed into 2026 coverage. These data do not necessarily translate to enrollments. That is because people who have selected a plan or been automatically renewed may not ultimately choose to pay for their coverage, thus “effectuating” their enrollment."

ACA Signups Are Down, But Still an Incomplete Picture

Data currently being released represent Open Enrollment ACA Marketplace plan selections, or how many people have signed up for or been automatically renewed into 2026 coverage. These data do not necessarily translate to enrollments. That is because people who have selected a plan or been automatically renewed may not ultimately choose to pay for their coverage, thus “effectuating” their enrollment.

KEY RESOURCES
  • Health Policy 101: Costs and Affordability

    This Health Policy 101 chapter explores trends in health care costs in the U.S. and the factors that contribute to this spending. It also examines how health care spending varies and the impact on affordability and people's overall financial vulnerability.  


  • Americans’ Challenges with Health Care Costs

    This data note reviews our recent polling data that finds that Americans struggle to afford many aspects of health care, including disproportionate shares of uninsured adults, Black and Hispanic adults and those with lower incomes.

  • National Health Spending Explorer

    This interactive Peterson-KFF Health System Tracker tool allows users to examine five decades worth of data on health expenditures by federal and local governments, private insurers, and individuals.

  • Polling on Prescription Drugs and Their Prices

    This chart collection draws on recent KFF poll findings to provide an in-depth look at the public’s attitudes toward prescription drugs and their prices. Results include Americans’ opinions on drug affordability, pharmaceutical companies, and various potential measures that could lower prices.

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  • What to Know About Pharmacy Benefit Managers (PBMs) and Federal Efforts at Regulation

    Issue Brief

    This brief provides an overview of the role of PBMs in managing pharmacy benefits, discusses recent federal legislation focusing on several elements of PBM business practices, and explains the potential federal budgetary impact of this legislation, which would have a relatively modest impact on the federal deficit, based on available CBO estimates.

  • Americans’ Challenges with Health Care Costs

    Issue Brief

    This data note reviews our recent polling data that finds that many Americans struggle to afford many aspects of health care, including disproportionate shares of uninsured adults, Black and Hispanic adults and those with lower incomes.

  • KFF Health Tracking Poll: Health Care Costs in the Current Moment of Economic Anxiety

    Poll Finding

    As economic anxiety rises, KFF's Health Tracking Poll finds that younger adult, LGBT adults, Hispanic adults, and adults with modest incomes are among groups most likely to report difficulty earning a living and affording health care. Large shares of those who are uninsured or purchase their own insurance also report challenges earning a living and paying for care.

  • Recent Trends in Commercial Health Insurance Market Concentration

    Issue Brief

    Commercial health insurance markets remain highly concentrated across coverage types. However, the individual market, which consists mostly of the ACA Marketplaces, has attracted more insurers and witnessed greater insurer competition across a variety of measures since the implementation of the enhanced premium tax credits in 2021, according to a new Healthy System Tracker analysis.

  • Health Policy in 2026

    From Drew Altman

    In a new column, President and CEO Dr. Drew Altman forecasts eight things to look for in health policy in 2026. “First and foremost,” he writes, “is the role health care affordability will play in the midterms.” And, he notes: “The average cost of a family policy for employers could approach $30,000 and cost sharing and deductibles will rise again after plateauing for several years.”

  • 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…

  • 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.