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    ACA Marketplace enrollees will see steep increases in premium payments in 2026 if the enhanced subsidies expire. Enrollees in 12 HealthCare.gov states would see their annual payments at least double on average.
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    Marketplace enrollment has more than doubled in 15 states since 2020, including in Texas, where signups more than tripled. None of the five states with the largest growth in recent ACA marketplace enrollment have expanded Medicaid under the ACA.
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    This Health Policy 101 chapter provides an overview of the Affordable Care Act (ACA), a major reform of the U.S. health care system aimed at reducing high uninsured rates and alleviating issues like high out-of-pocket costs and coverage exclusions for preexisting conditions.

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