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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: This Could Be the Next Big Issue in Health Reform

    Perspective

    No, this is not about “death panels.” The town hall meetings.  The media coverage of the town hall meetings.  Media polls about how the American people feel about the town hall meetings.  And even the media myth busting and fact checking about the most extreme claims made at the town hall meetings and the Administration's daily efforts to set the record straight.  All these things have focused attention on a few hot button issues that…

  • Rate Review: Spotlight on State Efforts to Make Health Insurance More Affordable

    Other Post

    The Patient Protection and Affordable Care Act creates a new federal role to examine “unreasonable increases” in the premiums charged for certain individual and small group health plans. Under the health reform law, the U.S. Department of Health and Human Services (HHS) will work with state insurance departments to conduct an annual review of unreasonable rate increases, and insurers must provide justification for such increases to HHS and to the public via their websites. The…

  • National ACA Marketplace Signups Dipped a Modest 3.7 Percent This Year

    News Release

    Overall ACA marketplace signups for 2018 dropped by 3.7 percent compared to last year’s enrollment period, a new analysis from the Kaiser Family Foundation finds. 11,760,533 people signed up for 2018 health insurance coverage on the ACA individual marketplaces, amid steep reductions in federal funding for outreach and navigators, an enrollment period half as long, and a climate of political uncertainty surrounding the law. The federal government also terminated cost-sharing subsidy payments to insurers in…

  • Approved Changes in Indiana’s Section 1115 Medicaid Waiver Extension

    Issue Brief

    On February 1, 2018, the Centers for Medicare and Medicaid Services (CMS) approved an amended extension of Indiana’s Healthy Indiana Program 2.0 (HIP 2.0) Section 1115 demonstration waiver. Indiana’s waiver initially implemented the ACA’s Medicaid expansion from February, 2015 through January, 2018 by modifying Indiana’s pre-ACA limited coverage expansion waiver (HIP 1.0). Unlike other states that implemented the ACA’s Medicaid expansion through a waiver, Indiana’s demonstration also changes the terms of coverage for non-expansion adults…

  • Understanding Short-Term Limited Duration Health Insurance

    Issue Brief

    In late 2017, President Trump issued an executive order directing the Secretary of Health and Human Services to take steps to expand the availability of short-term health insurance policies. This brief provides background information on short-term policies and how they differ from ACA-compliant health plans. It also analyzes the short-term plans available through two major online brokers to assess how often they include coverage for mental health, substance abuse, prescription drugs and maternity care.

  • Community Health Centers: Growing Importance in a Changing Health Care System

    Issue Brief

    Community health centers provide essential access to comprehensive primary care in underserved communities. This issue brief describes health centers and their patients in 2016 and examines changes in access to care and utilization of services by health center patients following implementation of the ACA coverage expansions in 2014.

  • Kaiser Health Tracking Poll – March 2018: Views on Prescription Drug Pricing and Medicare-for-all Proposals

    Feature

    More than a year into President Trump’s presidency, the March Kaiser Health Tracking Poll gauges the public’s top priorities for the president and Congress to do in the coming months. This month’s poll also measures perceptions on the cost of prescription drugs, attitudes towards policymakers’ actions to address drug prices, and views of pharmaceutical companies. In addition, with the 2018 midterm elections less than 8 months away, the KFF poll asks how important a national…

  • State and Federal Contraceptive Coverage Requirements: Implications for Women and Employers

    Issue Brief

    Before the ACA was passed, many states had enacted contraceptive equity laws that required plans to treat contraceptives in the same way they covered other services. In addition, since the ACA was passed, a number of states have enacted laws that basically codify in state legislation the ACA benefit rules. This issue brief provides an update on the status of the continuing litigation on the federal contraceptive requirement and explains the interplay between the federal…

  • Poll: Survey of the Non-Group Market Finds Most Say the Individual Mandate Was Not a Major Reason They Got Coverage in 2018, And Most Plan to Continue Buying Insurance Despite Recent Repeal of the Mandate Penalty 

    News Release

    Very Few Say They Would Want to Purchase a Short-Term Plan, A Regulation Being Drafted By The Trump Administration Nine in 10 enrollees in the non-group market say they intend to continue buying their own insurance even after being told that Congress has repealed the individual mandate penalty for not having coverage as of 2019, according to a new survey by the Kaiser Family Foundation. The survey finds the mandate, part of the Affordable Care…