Perhaps the most innovative provision of the Affordable Care Act (ACA) is the establishment of health insurance Marketplaces to facilitate the purchase of health coverage for individuals and small businesses. The ACA imposes a mandate on individuals to obtain health insurance if affordable coverage is available. To reduce the burden of this mandate, the ACA also provides income-related subsidies through tax credits for many adults with family incomes between 138 percent and 400 percent of the federal poverty level (FPL) who purchase individual coverage in the Marketplaces. In this brief, we examine pre-reform access to and affordability of health care for the population now eligible for Marketplace subsidies. The goal is to identify current problems with access and affordability and to suggest potential gains for adults likely to be affected by the ACA.