Many Americans are going to have sticker shock when they sign up for health insurance this year.

For the roughly half of Americans who get insurance through their work, premiums are set to grow by another 6 percent on average, up to roughly $27,000 per year for family coverage. That is a 26 percent increase since 2020. Costs have been steadily climbing for a long time now: Rates are more than twice as high as they were in 2010.

And then there are the 24 million people who buy insurance on the Affordable Care Act marketplaces who face much higher increases — by 30 percent on average next year because Congress can’t agree on a deal that would keep them lower. This is the sticking point at the center of the ongoing government shutdown.

Defending and expanding federal health care funding has been a winning issue for the Democrats since Republicans tried and failed to repeal the ACA in 2017. But is the law worth defending, really? If it has been such a success, then why are costs still climbing for the vast majority of Americans?

It’s a complicated story with a complicated answer.

The ACA was designed to expand coverage, not to control costs

The ACA has one unambiguous success: The uninsured rate in America is around 8 percent, roughly as low as it has ever been, half what it was before the law passed. More than 40 million people have been covered by either the marketplaces or Medicaid expansion.

But you would be forgiven for thinking the real purpose of the ACA was to lower the cost of health care for everyone: It is named, after all, the “Affordable Care” Act. And Democrats sold it on that premise.

“In the end, our goal is to make health care more affordable for families, businesses, and the federal government. If you have health insurance, the reforms we seek will bring stability and security you don’t have today,” President Barack Obama said in 2009 during a speech to Congress as the bill was being debated. “For those who don’t, we’ll offer you quality, affordable choices. And we’ll finally keep insurance companies from discriminating against those who are sick and need care the most.”

But in reality, affordable health care is still elusive. Most of the law’s provisions and funding focused on “those who don’t” — on expanding coverage to the uninsured. The vast majority of ACA spending was earmarked for financial assistance for people who buy insurance on the marketplaces or for covering the cost of expanded Medicaid for people who are in or near poverty.

For many of those people, the law has delivered clear benefits.

Insurance companies can no longer deny them coverage for preexisting conditions, and the federal government is stepping........

© Vox