Lately, I’ve been seeing and hearing a lot of confusion about the Affordable Care Act (ACA) and the cost of healthcare. Some people think the only reason insurance prices are “low” right now is because of COVID-19 — but that’s not quite true. The pandemic certainly changed many things, but it isn’t what’s keeping ACA coverage affordable today.

It’s more accurate to credit enhanced subsidies enacted through the American Rescue Plan (ARP) and extended by the Inflation Reduction Act (IRA) — policy choices, not the pandemic.

This confusion ties directly to something I explored in my recent Reverb post, Obamacare, the ACA, and the Language of Confusion: How Propaganda Became Policy — where I break down how political wordplay has warped public understanding of healthcare and other critical issues. Many Americans still believe “Obamacare” and “the ACA” are two different things, when in fact, they are one and the same. That simple rebranding created a lasting divide between perception and reality, and it’s a perfect example of how language can obscure truth.

I’m not a policy expert, but I am someone who does my research and tries to understand what’s really happening — and then share what I learn so others can, too. The truth is, while the ACA made health insurance more accessible, it didn’t fix the underlying problem: healthcare in America is still incredibly expensive. What’s changed is who pays how much, and that’s due to federal policy decisions, not COVID.

? 1. The ACA Helps With Insurance, Not Prices

The ACA’s biggest achievement was providing premium relief by making insurance affordable for millions through subsidies — premium tax credits that lower monthly payments based on income — and Cost-Sharing Reductions (CSRs) that help with out-of-pocket costs.
It also expanded Medicaid in many states, offering free or low-cost coverage to millions of low-income adults.

But these measures don’t actually reduce the price of healthcare services themselves — things like hospital stays, specialist visits, and prescription drugs. Those costs continue to climb every year.

? 2. The Real Drivers of High Costs

Even with the ACA in place, the U.S. remains the most expensive healthcare system in the world. Why?

Service Prices: American hospitals and doctors charge more for the same procedures than in other countries.
Prescription Drug Costs: The U.S. has some of the highest drug prices globally.
Administrative Overhead: Our complex system of private and public insurers creates layers of paperwork, billing, and management.
Provider Consolidation: When hospitals and healthcare systems merge, competition decreases and prices go up.

None of that is controlled by the ACA. The law focused on expanding coverage and protecting consumers, not regulating medical or pharmaceutical pricing.

? 3. COVID’s Temporary Role

During the pandemic, the government expanded ACA subsidies under the American Rescue Plan (2021) and later through the Inflation Reduction Act (2022). These enhanced subsidies helped more people qualify for assistance and reduced premiums even further.

That’s why many Americans saw prices drop — but it was because of policy, not COVID itself. These expanded subsidies are currently set to expire at the end of 2025 unless Congress extends them. If they aren’t renewed, many households could face major premium hikes starting with the 2026 plan year.

Analysts estimate that the annual out-of-pocket premium payment for the average subsidized enrollee would more than double — an estimated increase of 114% — going from around $888 per year to over $1,900. The return of the subsidy cliff means that middle-income families and older adults in particular will face devastating cost increases.

? 4. Affordability vs. Accessibility

Even with help from subsidies, many ACA plans — especially Bronze and Silver tiers — come with high deductibles. That means you might have to pay thousands out of pocket before insurance starts covering most expenses.

This is why many Americans are considered underinsured — they technically have coverage, but using it still feels financially out of reach. Furthermore, the sharp rise in premiums due to the expiration of the enhanced subsidies is projected to push an estimated 4 to 5 million Americans out of the insurance market entirely in 2026, reversing years of progress in reducing the national uninsured rate.

? My Takeaway

The Affordable Care Act was a huge step forward, but it was never meant to be a cure-all. It’s a bridge — a way to make coverage possible while the deeper problems of our healthcare system still wait for real reform.

So when people say “healthcare got cheaper because of COVID,” that’s not the full picture. It’s more accurate to say policy choices made it temporarily more affordable to access insurance, while the true cost of care continues to climb underneath.

For readers who want to go deeper into how political narratives shaped the public’s misunderstanding of the ACA in the first place, I encourage you to revisit my Reverb piece, Obamacare, the ACA, and the Language of Confusion. Together, these two reflections paint a fuller picture of how words, policy, and perception all interact — and why clarity still matters more than ever.

I don’t claim to have all the answers, but I believe in doing my homework — and sharing what I find so others can make sense of it too. Understanding these differences helps us see where change is still needed and why staying informed matters more than ever, especially as we approach the 2025 deadline for extending these vital subsidies.

If you found this helpful, consider sharing it with someone who’s been struggling to understand how healthcare costs really work. Knowledge is power — and together, we can use it to ask better questions and demand better answers.