ACA Marketplaces - Research and Data from KFF

Early Indications of the Impact of the Enhanced Premium Tax Credit Expiration on 2026 Marketplace Premiums

Jun 3, 2025

Issue Brief

Every summer, health insurers submit rate filings to state regulators detailing expectations and justifying premium rate changes for ACA-regulated health plans for the coming year. With the enhanced premium tax credits set to expire at the end of 2025, consumers can expect increases in how much they pay for coverage. KFF examines 23 early insurer premium filings from Vermont, Oregon, Washington, and Washington, DC, which include an additional 4 percent increase in premiums, on average,…

Expansions to Health Savings Accounts in House Budget Reconciliation: Unpacking the Provisions and Costs to Taxpayers 

May 29, 2025

Policy Watch

The House budget reconciliation bill contains various expansions to Health Savings Accounts (HSAs). This policy watch explains what HSAs are, how they have been used, what the key changes to HSAs would be, and how much they would cost the federal government.

Last-minute House Reconciliation Provision Would Set Up Clash with States over Marketplace Abortion Coverage

May 23, 2025

Quick Insights

Insurers in 12 states that require abortion coverage would not be able to access federal funding for reduced cost-sharing under the House provision. How this would get resolved, and what would happen to abortion coverage for low-income ACA enrollees in these states, is unclear.

The Spotlight Is on Medicaid Cuts, But the ACA Marketplaces Could See a One-Third Cut in Enrollment

May 20, 2025

From Drew Altman

In his latest column, President and CEO Drew Altman shows how proposals contained in the House reconciliation bill could result in a one-third reduction in ACA Marketplace enrollment. “While all eyes are on the big Medicaid cuts being proposed in the House,” he writes, “significant changes are also being proposed that together would dramatically reduce enrollment in the ACA Marketplaces.”

Marketplace Enrollees with Unpredictable Incomes Could Face Bigger Penalties Under House Reconciliation Bill Provision

May 19, 2025

Issue Brief

This analysis illustrates how provisions included in the House budget reconciliation bill could expose Marketplace enrollees with unpredictable incomes to higher penalties when filing taxes if they underestimate their incomes. About one in four potential Marketplace shoppers had incomes that varied at least 20 percent from the beginning to the end of the year.

The Debate About Enhanced Premium Tax Credits Begins to Emerge (Finally)

Apr 15, 2025

From Drew Altman

In his latest column, president and CEO Drew Altman discusses why debate about extending the ACA enhanced tax credits set to expire this year has been slow to develop, and why it could matter to Republicans politically if the tax credits are not extended.

The Rubber is About to Hit the Road on Medicaid Cuts

Apr 10, 2025

Quick Insights

Once Republicans in Congress get specific about Medicaid cuts, it will become more tangible and clearer who will be affected. Changes to the status quo in health care rarely get more popular when the details get filled in.

ACA Marketplace Enrollment Has More Than Doubled Since 2020, with the Fastest Growth Occurring in States Won by President Trump in 2024

Apr 2, 2025

News Release

Enrollment in Affordable Care Act (ACA) Marketplace health plans reached a record 24.3 million people, more than double the total in 2020, with most of the growth occurring in states won by President Trump in the 2024 election, a new KFF analysis finds. Almost all states have seen increases in enrollment since 2020, including six states where enrollment has more than tripled: Texas (up 255%), Mississippi (up 242%), West Virginia (up 234%), Louisiana (up 234%),…

Enrollment Growth in the ACA Marketplaces

Apr 2, 2025

Policy Watch

This analysis of enrollment in Affordable Care Act (ACA) Marketplace health plans finds a record 24.3 million people enrolled in 2025, more than double the total in 2020, with most of the growth occurring in states won by President Trump in the 2024 election. In six states, enrollment more than tripled from 2020 to 2025: Texas, Mississippi, West Virginia, Louisiana, Georgia, and Tennessee.

Who Might Lose Eligibility for Affordable Care Act Marketplace Subsidies if Enhanced Tax Credits Are Not Extended?

Mar 3, 2025

Policy Watch

This analysis looks at the individual market enrollees who make at least four times the federal poverty level who would no longer be eligible for any tax credits if the current ACA Marketplace enhanced subsidies expire at the end of this year. Compared to other people with similar incomes, these enrollees are more likely to be early retirees, self-employed and living in rural areas.

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