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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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  • El plan de salud de mi empleador tiene una opción de bienestar que me obliga a pagar una prima más alta si no cumplo con ciertos objetivos de salud o si no participo en absoluto. No puedo pagar esas pri...

    FAQs

    Eso depende. Si su contribución a la prima con la penalización por bienestar sería superior al 9.96% de sus ingresos en 2025, entonces el plan de su empleador se consideraría inasequible y usted sería elegible para solicitar créditos fiscales para las primas en el mercado de seguros. Esta prueba se aplica independientemente de que usted sea realmente sancionado o no, y antes de que se aplique la sanción (por ejemplo, si su empleador le da…

  • ¿El período de inscripción abierta es el mismo para Medicare y los mercados de seguros de salud?

    FAQs

    Existe cierta superposición en los períodos de inscripción para Medicare y los mercados de seguros, pero este año no son los mismos. El período de inscripción abierta de Medicare se extiende del 15 de octubre al 7 de diciembre de cada año. Para la cobertura del mercado de 2026, el período de inscripción abierta se extenderá desde el 1 de noviembre de 2025 hasta el 16 de enero de 2024 en los estados que utilizan…

  • What to Watch in the 2024 ACA Open Enrollment

    Policy Watch

    With the start of the 2024 Affordable Care Act open enrollment, the Marketplaces have been operating for a full decade and are heading into their eleventh year. This policy watch outlines changes to watch out for during 2024 Open Enrollment.

  • Compré anticonceptivos de emergencia de venta libre en mi farmacia y pensé que mi seguro los cubriría, pero terminé teniendo que pagar el costo total de mi bolsillo. ¿Por qué no lo cubre mi seguro?

    FAQs

    La anticoncepción de emergencia es uno de los métodos aprobados por la Administración de Drogas y Alimentos (FDA) para mujeres que debe estar cubierto por la mayoría de los planes de salud, incluidos los que se venden en el mercado de seguros. Sin embargo, debe ser recetada por un profesional de salud para que la mayoría de los planes la cubran. Si no tiene una receta, probablemente tendrá que pagar el costo total de su…

  • 10 Million Have Been Disenrolled from Medicaid; Some Could Find Themselves Eligible for Marketplace Subsidies

    News Release

    More than 10 million people have been disenrolled from Medicaid, based on data available from 50 states and the District of Columbia as of November 1, 2023. Disenrollment rates range from 65% in Texas to 10% in Illinois, according to KFF’s ongoing tracking. Differences in state renewal policies and system capacity likely explain some of this variation. Some disenrolled individuals are regaining Medicaid coverage. As a result, overall declines in Medicaid enrollment will be less…

  • Preventive Services Use Among People with Private Insurance Coverage

    Issue Brief

    This analysis of claims data estimates that six in ten people with private health insurance - or about 100 million people - used at least one preventive service covered without any out-of-pocket costs through a provision of the Affordable Care Act (ACA) in a typical year prior to the COVID-19 pandemic (2018). The provision that requires most private health plans to cover many preventive services without any cost-sharing for their enrollees is being challenged in…

  • 2026 Medical Loss Ratio Rebates

    Issue Brief

    Insurers estimate they will pay $759.2 million in Medical Loss Ratio (MLR) rebates in 2026 to select individuals and employers that purchase their health coverage, according to a KFF analysis of preliminary data reported to state regulators. The estimated rebate for 2024 is less than rebates issued in most prior years.

  • Coverage Expansions and the Remaining Uninsured: A Look at California During Year One of ACA Implementation

    Report

    California is a bellwether state for understanding the impact of the Affordable Care Act (ACA). Much attention has been paid to enrollment in California's new coverage options, such as the Medicaid expansion (Medi-Cal) and plans sold through ACA marketplaces (Covered California), and to changes in the uninsured from 2013 to 2014. However, less is known about how this coverage has affected people’s access to care and financial security, and why others remain uninsured. This report,…

  • Round 2 on the Legal Challenges to Contraceptive Coverage: Are Nonprofits “Substantially Burdened” by the “Accommodation”?

    Issue Brief

    The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for a broad range of preventive services including Food and Drug Administration (FDA) approved prescription contraceptives and services for women. Since the implementation of the ACA contraceptive coverage requirement in 2012, over 200 corporations have filed lawsuits claiming that including coverage for contraceptives or opting for an “accommodation” from the federal government violates their religious beliefs. This brief explains the legal…