Did Obamacare Raise Premiums? Costs, Spikes, and 2026 Changes

Yes — the Affordable Care Act raised premiums in the individual health insurance market, and by a lot on paper. Benchmark marketplace premiums roughly doubled in nominal terms between 2013 and 2019, driven by new rules that made policies cover more and accept sicker people. But that sticker-price answer misses most of what happened. Federal subsidies absorbed the increases for the large majority of marketplace enrollees, the plans people bought after 2014 covered substantially more than what came before, and the buyers who actually felt the higher prices were those earning too much to qualify for financial help. Whether Obamacare raised your premium depends almost entirely on which side of that subsidy line you were on.

How Much Premiums Actually Rose

The cleanest measure is the benchmark plan — the second-lowest-cost silver plan on the marketplace, which is also the plan subsidies are calculated against. KFF data show the national average monthly benchmark premium for a 40-year-old was $273 in 2014, rose modestly to $299 by 2016, then jumped to $481 by 2018, a 76 percent increase in four years. It drifted down to $438 by 2022 before climbing to $497 in 2025 and $625 in 2026.¹

Looking at the individual market as a whole rather than just the benchmark, the Heritage Foundation calculated a 129 percent increase in average monthly premiums between 2013 and 2019, from $244 to $558, with premiums more than doubling in 40 states.² The Paragon Health Institute found ACA benchmark premiums grew 129 percent from 2014 to 2026, roughly twice the 68 percent growth in average employer-sponsored premiums over the same span.³

Those numbers are real. They also aren’t the whole picture, because the product being priced changed in 2014.

Why the ACA Pushed Prices Up

Before 2014, insurers in the individual market could deny coverage to people with pre-existing conditions, charge sick people far more, exclude entire categories of benefits, and cap what they’d pay out over a year or a lifetime. The risk pool skewed young and healthy by design. Average claims costs in the individual market in 2010 were just $177 per member per month, compared to $273 in the employer market, because expensive people were kept out.⁴

The ACA changed several rules at once, and each one added to premiums:

Guaranteed issue and the ban on medical underwriting brought sicker, costlier people into the pool. Actuarial firm Milliman projected these risk-pool changes alone would raise 2014 premiums by 20 to 45 percent.⁵
Essential health benefits required plans to cover ten categories of care, including maternity, mental health, and prescription drugs — services many pre-ACA plans had excluded. Milliman put the added cost at 3 to 17 percent depending on the state.⁵
Age-rating limits capped the premium ratio between the oldest and youngest adults at 3-to-1, replacing the roughly 5-to-1 ratio common before. Urban Institute modeling found a 21-to-27-year-old paid about $850 more per year under the tighter rule, while a 57-to-64-year-old paid about $1,770 less.⁶
A minimum actuarial value of 60 percent added roughly 8.5 percent across the market.⁵
New taxes and exchange fees added about 4.4 percent.⁵

Research by Amanda Kowalski for the Brookings Papers on Economic Activity estimated the combined effect pushed individual-market premiums 24.4 percent higher than the pre-existing trend, just in the shift from late 2013 to mid-2014.⁷

The Comparison Problem

Defenders of the law argue that lining up 2013 and 2014 premiums side by side treats them as the same product when they aren’t. A 2016 analysis by Loren Adler and Paul Ginsburg, published through Brookings and Health Affairs, found the average 2014 benchmark silver premium was actually 10 to 21 percent lower than the average 2013 individual-market premium. Because silver plans covered about 70 percent of medical costs versus roughly 60 percent for the average pre-ACA plan, the researchers estimated consumers were getting 23 to 32 percent more value per dollar.⁸

The same work drew on AHIP survey data showing the average individual-market base premium in 2009 was $2,985 annually, with those premiums growing 5 to 12 percent per year before the marketplaces opened.⁹ Premiums were climbing before the ACA, and by that reading the law bent the trajectory rather than starting a new one. The Congressional Budget Office had projected in 2009 that ACA regulations would raise average individual premiums by 10 to 13 percent relative to a no-law baseline, and that subsidies would more than offset the increase for most buyers.¹⁰

Who Actually Paid More

For most marketplace enrollees, the sticker price is not what comes out of the checking account. Premium tax credits are calculated on a sliding scale tied to income, and 92 percent of marketplace enrollees qualified for them in both 2024 and 2025.¹¹¹² Because subsidies are pegged to the benchmark plan, when premiums rise, subsidies generally rise with them, insulating lower-income enrollees.

The enhanced premium tax credits introduced by the American Rescue Plan Act in 2021 and extended through 2025 by the Inflation Reduction Act widened that protection. They capped what anyone paid for the benchmark plan at 8.5 percent of household income and eliminated the old subsidy cliff at 400 percent of the federal poverty level.¹³ Marketplace enrollment roughly doubled under those enhanced credits, from 11.4 million in 2020 to 24.3 million in 2025.¹⁴

Buyers who didn’t qualify for subsidies got no such buffer. Middle-income individuals and families above the eligibility threshold paid the full increase, and KFF noted many of them had been “priced out of the market” by 2019.¹⁵

The 2017–2018 Spike

The sharpest single jump came between 2016 and 2018, when the benchmark premium leaped from $299 to $481. That wasn’t primarily about the law’s original rules. It reflected the collapse of the ACA’s temporary market-stabilization programs.

The reinsurance program pumped $10 billion into the individual market in 2014, dropped to $4 billion in 2016, and expired. Those payments had been effectively subsidizing premiums.¹⁶ The risk corridor program, designed to move money from profitable insurers to those losing money, ran short almost immediately: 2014 claims came in at $2.87 billion against just $362 million in contributions, and Congress then barred HHS from using other funds to make up the gap. Economists estimate the effective end of that program accounts for roughly 86 percent of premium growth between 2015 and 2017.¹⁷

Insurers had underpriced their early products partly because those backstops existed. When they went away, a large correction followed. Congress then zeroed out the individual mandate penalty effective January 2019 as part of the 2017 Tax Cuts and Jobs Act. Among insurers that publicly quantified the effect, KFF found 2019 premiums came in about 6 percent higher than they otherwise would have been due to the mandate repeal and the expansion of loosely regulated short-term plans.¹⁵ Here again, subsidized enrollees were largely shielded; the impact landed on unsubsidized buyers, especially those purchasing off-exchange.

What Happened in the Employer Market

Most Americans get insurance through work, and the ACA’s heaviest regulations applied to the individual and small-group markets. The employer-sponsored market, largely exempt from requirements like essential health benefits and community rating, saw much slower premium growth. Heritage Foundation data show large-group employer premiums rose 29 percent between 2013 and 2019, compared to 129 percent in the individual market.²

Overall health care cost growth did slow after the law’s passage, though economists disagree about how much credit the ACA deserves. A 2020 Health Affairs study found annual health-spending growth fell from 6.9 percent in 2000–2009 to 4.3 percent in 2010–2018, with lower general inflation in the later period likely a factor.¹⁸ Federal data from the Agency for Healthcare Research and Quality show employer single-coverage premiums grew at an average annual rate of 4.2 percent between 2008 and 2020.¹⁹

What Changed in 2026

The enhanced premium tax credits expired at the end of 2025 without renewal by Congress.²⁰ The Urban Institute reported benchmark premiums jumped 21.7 percent for 2026, far above the 2.0 percent average annual growth from 2020 to 2025, reflecting rising medical costs, the expected loss of healthier enrollees, and uncertainty tied to the reconciliation legislation known as the One Big Beautiful Bill Act.²¹

For consumers, the effect was sharp. Average monthly premium payments after tax credits rose 58 percent, from $113 in 2025 to $178 in 2026. Average deductibles climbed 37 percent to a record $3,786. Enrollees shifted toward cheaper bronze plans, and total marketplace sign-ups fell to 23.1 million, the steepest single-year decline the marketplace has seen, with effectuated enrollment projected to drop to roughly 17.5 million.¹² KFF estimated that with the enhanced subsidies gone, subsidized enrollees would face a 114 percent increase in annual premium payments on average.¹³

The Bottom Line

The ACA raised the sticker price of individual-market insurance. Pre-existing-condition protections, mandatory benefit floors, and tighter age-rating all added cost to policies that had previously been cheap partly because they excluded sick people and covered less. The initial jump was somewhere between 10 and 25 percent, and the compounding through 2019 roughly doubled nominal premiums.

Those sticker prices weren’t what most marketplace enrollees paid. Subsidies absorbed the bulk of the increases for lower- and middle-income buyers, and the coverage on offer was meaningfully more comprehensive than what it replaced. The people who felt the higher prices were those who earned too much to qualify — a group that shrank while the enhanced credits were in effect and is growing again now that those credits have expired. Whether Obamacare raised your premium in a way that mattered comes down to which side of the subsidy line you were on.

1
KFF. Marketplace Average Benchmark Premiums
2
The Heritage Foundation. Obamacare Has Doubled the Cost of Individual Health Insurance
3
Paragon Health Institute. Obamacare Plan Premiums Have Increased Nearly 2x Faster Than Employer-Based Premiums Since 2014
4
Peterson-KFF Health System Tracker. How ACA Marketplace Costs Compare to Employer-Sponsored Health Insurance
5
The Heritage Foundation. How Obamacare Raised Premiums
6
Urban Institute. Why the ACA’s Limits on Age Rating Will Not Cause Rate Shock
7
Brookings Institution. The Early Impact of the Affordable Care Act
8
Brookings Institution. Affordable Care Act Premiums Are Lower Than You Think
9
USC Schaeffer Center. Affordable Care Act Premiums Are Lower Than You Think
10
State of Indiana. CBO Comparison Executive Summary
11
Urban Institute. Health Insurance Premium Tax Credit
12
KFF. What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles
13
KFF. ACA Marketplace Premium Payments Would More Than Double on Average Next Year if Enhanced Premium Tax Credits Expire
14
Peterson-KFF Health System Tracker. Early Indications of the Impact of the Enhanced Premium Tax Credit Expiration on 2026 Marketplace Premiums
15
KFF. How Repeal of the Individual Mandate and Expansion of Loosely Regulated Plans Are Affecting 2019 Premiums
16
KFF. Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors
17
National Bureau of Economic Research. NBER Working Paper on Risk Corridors and Marketplace Premiums
18
EconoFact. Fact Check: Have Healthcare Costs Risen Faster Since the Affordable Care Act Was Passed
19
Agency for Healthcare Research and Quality. MEPS Statistical Brief 536
20
Bipartisan Policy Center. Enhanced Premium Tax Credits: Who Benefits, How Much, and What Happens Next
21
Urban Institute. Understanding the Extraordinary Increase in ACA Premiums in 2026