{"id":12092,"date":"2026-03-18T10:00:00","date_gmt":"2026-03-18T10:00:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=12092"},"modified":"2026-03-18T10:00:00","modified_gmt":"2026-03-18T10:00:00","slug":"evidence-shows-acas-mandated-benefits-alone-dont-drive-up-costs-the-debate-continues","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=12092","title":{"rendered":"Evidence Shows ACA\u2019s Mandated Benefits Alone Don\u2019t Drive Up Costs. The Debate Continues."},"content":{"rendered":"

In January, when President Donald Trump unveiled his one-page outline to address health care spending, dubbed \u201cThe Great Healthcare Plan<\/a>,\u201d he specifically mentioned the Affordable Care Act\u2019s role in driving up costs.<\/p>\n

\u201cI call it the unaffordable care act,\u201d he said. He reprised the line in his 2026 State of the Union<\/a> address, blaming \u201cthe crushing cost of health care\u201d on Obamacare.<\/p>\n

Trump\u2019s words also play off an ongoing congressional debate that began late last year with the expiration of the enhanced tax subsidies that had lowered the cost of ACA insurance for millions of Americans \u2014 and thrust the issue of ACA-related costs back to center stage.<\/p>\n

Without those enhanced subsidies, the amount people pay toward monthly Obamacare premiums doubled, on average. The number of people enrolled in ACA coverage for this year has dropped by more than a million, and experts say more people could abandon coverage once premiums come due. Democrats are using this development to crank up the heat on Republicans ahead of the November elections and steer the conversation on the affordability issue.<\/p>\n

Republicans fault the law itself for driving up these costs. For instance, Rep. Mike Lawler (R-N.Y.) has said<\/a> that premiums \u201cskyrocketed across the country since it took effect.\u201d<\/p>\n

Critics routinely point to several provisions within the ACA as the culprits \u2014 among them, essential health benefits, or EHBs. Under the law, Obamacare plans must cover certain essential services, including emergency care, hospitalization, maternity, and prescription drugs, without annual or lifetime dollar limits. But connecting EHBs to the premium increases felt by consumers is not straightforward.<\/p>\n

Here\u2019s a primer on key issues involved.<\/p>\n

Checking the Numbers<\/strong><\/p>\n

It\u2019s clear that Obamacare premiums have increased.<\/p>\n

An analysis by the right-leaning Paragon Health Institute shows that the average premium for a 50-year-old with Obamacare grew by 129%<\/a> since 2014. The average premium for employer-based plans grew 68% during that same time.<\/p>\n

Paragon\u2019s president, Brian Blase<\/a>, told KFF Health News that this shows the ACA has made health care on the individual market more expensive.<\/p>\n

Still, the comparison overlooks a couple of points. Pre-ACA, employer plans generally offered more generous coverage than individual market plans, so work-based coverage cost more. And individual plans were cheaper in part because they could bar applicants with health problems. Beginning in 2014, the ACA forced individual policies to look more like employer plans, covering a broader range of benefits and accepting both healthy and unhealthy applicants. As a result, premiums rose that first year. In the years that followed, ACA plans often experienced faster growth in premiums than job-based plans. Some policy analysts say this isn\u2019t surprising because ACA plans started at a lower dollar base and had more room to rise.<\/p>\n

States that saw less dramatic post-ACA premium increases, such as Massachusetts and New York, already mandated that individual-market plans provide EHB-like coverage, noted Edmund Haislmaier<\/a>, a senior research fellow at the Heritage Foundation, a conservative think tank. These states also had higher premiums due to that and other provisions, such as not allowing plans to exclude people with preexisting conditions.<\/p>\n

\u201cIt was a combination of things,\u201d he said.<\/p>\n

Blase acknowledges that the two types of insurance started at different price points. But he said the percentage change over time shows that the ACA faces \u201cunderlying inflationary pressures\u201d \u2014 including the now-expired, more generous, covid pandemic-era subsidies \u2014 that affect its policyholders more so than employer plans.<\/p>\n

Aside from that point, however, premiums on the individual insurance market<\/a> were on the rise even before the ACA took effect.<\/p>\n

An analysis by Jonathan Gruber at the Massachusetts Institute of Technology found that between 2008 and 2010, premiums grew by at least 10% a year and were highly variable across states and insurers.<\/p>\n

Consumers\u2019 Other Costs<\/strong><\/p>\n

Over time, ACA deductibles \u2014 the amounts policyholders must satisfy in a given year before insurance kicks in \u2014 have seen large increases, with \u201cbronze\u201d plans now averaging $7,476 annually, up from $5,113 in 2014, according to KFF, a health information nonprofit that includes KFF Health News. Bronze plans tend to have lower premiums than the other metal-level categories \u2014 \u201csilver,\u201d \u201cgold,\u201d and \u201cplatinum\u201d \u2014 in part because of their higher deductibles.<\/p>\n

The Trump administration is doubling down on high-deductible plans as part of its emphasis on affordability, making it easier this year for people age 30 and up to qualify for what are called \u201ccatastrophic plans.\u201d These come with even larger deductibles than bronze plans.<\/p>\n

The administration pitched a broad regulatory plan for 2027<\/a> to cement those changes, saying it was designed to lower premiums and expand choices. It would raise next year\u2019s deductibles for catastrophic plans to $15,600 a year for an individual or around $30,000 for a family. It isn\u2019t clear how popular such plans would be. Detailed enrollment figures for this year are not yet available, but estimates indicate only about 54,000 people<\/a> chose catastrophic plans in 2025, and consumers can\u2019t use federal subsidies to purchase them.<\/p>\n

Before this Trump proposal, though, recent data showed that the rising rate of ACA plan deductibles had not outpaced deductibles for employer plans.<\/p>\n

The weighted average \u2014 a calculation that gives more weight to ACA plans with the most people enrolled \u2014 shows about a 55% increase<\/a> in annual deductible amounts since 2014, from $1,881 to $2,912. During that same period, deductibles in plans offered by employers rose on average<\/a> 59%, from $1,186 to $1,886, according to KFF\u2019s annual employer survey.<\/p>\n

Essential What?<\/strong><\/p>\n

To be clear, the ACA\u2019s catastrophic and bronze plans must cover essential health benefits, as do all Obamacare plans. These EHBs fall into 10 categories of medical services and were included in the ACA to ensure individual policies meet a minimum standard of coverage and are comparable to employer-based health insurance.<\/p>\n

Preventive services, such as annual checkups, vaccines, and certain cancer screenings, must be covered at no additional cost to patients. All plans must completely cover the cost of specific vaccines, including the annual flu shot. And insurers cannot refuse to pay for emergency care provided at an out-of-network hospital. Other EHBs are subject to out-of-pocket costs, such as copays at the doctor\u2019s office or pharmacy counter.<\/p>\n

In some ways, EHBs save money because they\u2019ve increased access to preventive care, said Gerard Anderson<\/a>, a professor of health policy and management at Johns Hopkins University\u2019s Bloomberg School of Public Health.<\/p>\n

Services such as cancer screenings and lab tests can lead to earlier detection of serious conditions, when treatment is less costly, and positive outcomes are more likely.<\/p>\n

\u201cIf you look down the list of essential health benefits, I think most people would reach the judgment that those are health care services that people should have access to,\u201d said Larry Levitt, KFF\u2019s executive vice president for health policy.<\/p>\n

Joseph Antos, a senior fellow emeritus at the conservative American Enterprise Institute, said ACA requirements \u2014 such as requiring insurers to accept anyone, regardless of their health status, and limiting insurers\u2019 ability to charge older people more for coverage \u2014 also have played roles in boosting premiums.<\/p>\n

\u201cReally, it\u2019s practically impossible to tease any one thing out,\u201d Antos said.<\/p>\n

States do have latitude to add benefits that fall under the EHB umbrella. For example, bariatric surgery is covered as an EHB in West Virginia<\/a>, but not in Pennsylvania<\/a>. Pennsylvania\u2019s EHBs also don\u2019t include hearing aids, but New Jersey\u2019s<\/a> do.<\/p>\n

But the Trump administration\u2019s 2027 regulatory proposal doesn\u2019t cast this flexibility in a positive light<\/a>: When \u201cstates enact benefit mandates, plan premiums must generally increase to account for the additional coverage,\u201d it reads. It also signals that added benefits can raise consumer costs and proposes that states be required to use their own funds to offset some of those costs.<\/p>\n

Paragon\u2019s Blase echoed this take in his bottom line. Mandating that plans cover EHBs without annual or lifetime caps, as required under the ACA law, encourages clinicians to overbill and overprescribe, he said. That drives up premiums and means a bigger check for insurers and medical providers at the expense of taxpayers. \u201cYou just turn patients into money factories,\u201d he said.<\/p>\n

Stacey Pogue<\/a>, a senior research fellow at Georgetown University\u2019s Center on Health Insurance Reforms, disagrees, saying that whatever EHBs\u2019 role, they aren\u2019t to blame for the year-over-year premium hikes.<\/p>\n

People aren\u2019t consuming medical care at exponential rates just because certain services are now covered: \u201cMe not paying anything for that colonoscopy doesn\u2019t make me want to get more of them,\u201d she said.<\/p>\n

Are you struggling to afford your health insurance? Have you decided to forgo coverage?\u00a0Click here<\/a>\u00a0to contact KFF Health News and share your story.<\/em><\/p>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n

USE OUR CONTENT<\/h3>\n

This story can be republished for free (details<\/a>).<\/p>","protected":false},"excerpt":{"rendered":"

In January, when President Donald Trump unveiled his one-page outline to address health care spending, dubbed \u201cThe Great Healthcare Plan,\u201d he specifically mentioned the Affordable Care Act\u2019s role in driving up costs. \u201cI call it the unaffordable care act,\u201d he said. He reprised the line in his 2026 State of the Union address, blaming \u201cthe…<\/p>\n","protected":false},"author":0,"featured_media":12093,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-12092","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/12092"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=12092"}],"version-history":[{"count":1,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/12092\/revisions"}],"predecessor-version":[{"id":12096,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/12092\/revisions\/12096"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/12093"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=12092"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=12092"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=12092"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}