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Affordable Care Act

The ACA MarketplaceS

Change in February effectuated enrollment, by state, 2025-2026

How Has ACA Marketplace Enrollment Changed Across States in 2026?

ACA Marketplace enrollment fell this year in every state except New Mexico, which was the only state to fully replace the enhanced premium tax credits that expired last year with a state-funded subsidy, according to a new KFF analysis of effectuated enrollment data. The Marketplace enrollment decline—the first in seven years—follows several years of rapid enrollment growth and coincides with the end of the enhanced federal subsidies.

How Much and Why ACA Marketplace Premiums Are Going Up in 2027

ACA Marketplaces insurers are proposing a median premium increase of 15% in 2027, according to KFF’s updated analysis of 276 insurers with publicly available filings across all 50 states and the District of Columbia. This is the second consecutive year of double-digit premium hikes. Last year’s median nationwide proposed rate change was 18%, and the median finalized rate change was 20%. While this proposed rate change is lower than last year, it represents the second-highest requested rate change since 2018, as premium growth had been relatively flat in this market for several years.

About the ACA

Promotional image for KFF video How Affordable is the Affordable Care Act

Did the Affordable Care Act Make Health Care More Affordable?

The expiration of the ACA’s enhanced premium tax credits at the start of 2026, combined with rising insurer premiums, put a spotlight on health care affordability that extends beyond Marketplace enrollees. KFF’s Cynthia Cox examines the ACA’s record and the broader underlying question it raises: what’s a fair price for Americans people to pay for health care?

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  • Number of States Affected by Key Medicaid Provisions in the 2025 Reconciliation Law

    Which States Will Be Affected by Key Medicaid Provisions in the 2025 Reconciliation Law?

    Policy Watch

    The 2025 reconciliation law makes sweeping changes to Medicaid that will affect every state through key eligibility and financing changes, including new work requirements, immigrant eligibility restrictions, and changes to provider taxes and state directed payments. This issue brief explains which states will be affected by each of these key provisions.

  • “…voters’ concerns about health care costs are having a moment, and will continue to do so through 2028, because voters see them as a dimension of their worries about the cost of living, which is their dominant concern right now.” — Drew Altman, KFF Founding President and CEO

    A Guide to the Role of Health in the Midterms

    From Drew Altman

    In a new column, President and CEO Dr. Drew Altman says health care costs are playing a significant role in the midterms as one dimension of voters’ concerns about cost of living, and explains why pollsters, analysts, and candidates should look at it that way, and not as a separate voting issue. He writes, “The ‘issue’ that matters most in this election is cost of living and the cost of health care is a central…

  • Midterm Election Update: The Affordable Care Act Marketplaces

    Fact Sheet

    More people than ever got coverage through the Affordable Care Act (ACA) Marketplaces in 2025, but the expiration of enhanced premium tax credits has driven up what people pay and contributed to declining enrollment in 2026. Law and regulatory changes also tightened ACA eligibility and enrollment requirements. Public opinion of the ACA remains generally favorable, although views remain divided along partisan lines.

  • Democrats Hold a Nearly 2-to-1 Advantage Over Republicans on Handling the Cost of Health Care

    Poll: Cost of Health Care and Gas Top Voters’ Midterm Concerns; Democrats Hold Significant Advantage on Health Care Costs and Cost of Living 

    News Release

    Just a month away from the midterm elections, affordability worries continue to top the public’s list of midterm election issues, with health care costs and gas costs tying as the top economic concern, KFF’s new Health Tracking Poll finds. Voters overall trust Democrats more than Republicans to handle the cost of health care and the cost of living.

  • Democrats Hold a Nearly 2-to-1 Advantage Over Republicans on Handling the Cost of Health Care

    KFF Health Tracking Poll: Health Care Issues in the Lead-Up to the 2026 Midterm Election 

    Poll Finding

    With the 2026 midterms about a month away, health care costs remain tied with gas as voters’ top midterm concerns and the Democrats hold a clear edge over the Republicans Party on who voters trust to handle many top electoral issues, including the cost of health care and the cost of living. Two-thirds of U.S. adults now favor Medicare-for-all, a new high in KFF Polling, but support shifts when competing claims from critics and proponents…

  • Status of State Medicaid Expansion Decisions

    Interactive

    This page displays an interactive map of the current status of state decisions on the Affordable Care Act's Medicaid expansion. Additional Medicaid expansion resources are listed (with links) below the map.

  • Quote from KFF President and CEO Drew Altman reads, "when it comes to the “affordability crisis” driving the national discussion of health care today, the chronically ill, and most of all the chronically ill uninsured, are the tip of the spear."

    The Group that Struggles the Most in American Health Care

    From Drew Altman

    In a new column, Dr. Drew Altman, KFF's Founding President and CEO, previews findings about the chronically ill uninsured from a large KFF survey of 25,000 Americans focusing on the cost and access challenges facing the chronically ill, which will be released tomorrow. He writes: “There are more than enough needs to go around in American health care, but if I had to pick the one group that struggles the most with costs and access,…