The Affordable Care Act (ACA) was promoted as a way to make health insurance more affordable. In reality, its regulations, which primarily affected the individual market, led premiums to increase an average of 47% from 2013 to 2014 (the year the law was implemented).
Since 2014, ACA plan premiums have increased much faster than employer-sponsored insurance (ESI) premiums, suggesting that the law’s regulatory and subsidy structures are even more inflationary those in the ESI market.
This Paragon PIC shows the percent increase in total premiums (the full amount paid by both enrollees and the federal government) for ACA benchmark plans compared to the increase in ESI premiums and the Consumer Price Index (CPI) from 2014 to 2026.
- ACA benchmark premiums increased 129 percent for a 50-year-old enrollee—about the average age of ACA participants.
- Average ESI premiums increased 68 percent.
- The CPI increased 39 percent.
A particularly large increase in premiums occurred in 2018, driven by “silver loading”—the practice of inflating ACA silver plan premiums to cover insurers’ Cost-Sharing Reduction (CSR) obligations after a court ruled that the Obama administration’s CSR payments were unlawful. After the federal government halted CSR payments in 2017, insurers still had to offer CSR plans to eligible enrollees. To recoup these costs, insurers increased premiums on silver plans, which are used to calculate benchmark premiums and determine premium tax credits (PTCs).
ACA plan premiums are spiking in 2026, because of underlying problems with the law and cost pressures from treatments like GLP-1s. Insurers state that only about one-fifth of the premium increase stems from the expiration of the COVID credits— largely because ending those credits will move zero-claim enrollees off the program. The ACA was intended to improve affordability, but after more than a decade, the data show a consistent pattern: premiums are rising much faster than ESI premiums, even as federal subsidies, which limit enrollee exposure to the premium, balloon.
The ACA subsidy structure is itself inflationary—driving up health care prices and total premiums. As Congress considers the future of the COVID Credits (expanded PTCs) and broader health-insurance reforms, it must confront the reality that the ACA made coverage far less affordable.
