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The ACA MarketplaceS

How Has Marketplace Enrollment Changed Across States in 2026?

Following several years of rapid enrollment growth in the ACA Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the enhanced tax credits, generally saw lower drops in enrollment.

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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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  • The Public’s Policy Agenda for the 113th Congress: Briefing and Panel Discussion

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    As the 113th Congress is sworn in, and President Barack Obama begins his second term of office, a comprehensive new Kaiser Family Foundation/Robert Wood Johnson Foundation/Harvard School of Public Health survey queried the public about their priorities for, and views on, a wide range of health and health policy issues. These include issues that will preoccupy federal lawmakers, such as the role of Medicare in the deficit reduction debate, as well as issues currently being…

  • Behavioral Health: Can Primary Care Help Meet the Growing Need?

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    The health reform law has specific provisions covering mental health and substance use conditions, as well as general provisions to benefit those in need of behavioral health services. While addressing unmet needs, the reform law provisions raise new challenges. Given their budgetary constraints, will states be able to expand capacity to meet the demands of increased enrollment? Will sacrifices in other benefits and services be needed in order to provide mental health parity? Will the…

  • Briefing on State Medicaid Programs, the Recession and Health Reform

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    The Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU) held a 9:30 a.m. ET briefing on Thursday, September 30 to examine the challenges facing states as they continue to struggle with the lingering impacts of the recession and begin preparing to implement health reform. Three reports were released at the event: Hoping for Economic Recovery, Preparing for Reform: A Look at Medicaid Spending, Coverage and Policy Trends: Results from a 50-State Medicaid Budget…

  • New Analysis Shows Effect of Rising Unemployment on Health Coverage, Medicaid and SCHIP Spending and Enrollment

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    As the country faces another economic downturn, many states are scrambling to deal with the impact of poor economic conditions on programs, like Medicaid and the State Children’s Health Insurance Program (SCHIP), that are reliant on state funding. To be better able to cope, states are looking for fiscal relief from the federal government as well as obtaining a moratorium on federal regulations that would reduce Medicaid funding for states from the Congress. New analyses…

  • Medicaid and CHIP Coverage In An Era of Recession and Health Reform

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    Despite tight budgets, nearly all states maintained or made targeted expansions or improvements in their Medicaid and Children’s Health Insurance Programs (CHIP) eligibility and enrollment rules in 2010, preserving the programs’ important role of providing coverage to millions of low-income Americans who otherwise lack affordable options. This stability in large part reflects the temporary fiscal relief for Medicaid provided by the American Recovery and Reinvestment Act of 2009 (ARRA) that was tied to requirements for…

  • Who is eligible for Marketplace premium tax credits?

    FAQs

    Premium tax credits are available to U.S. citizens and certain lawfully present immigrants who purchase coverage in the Marketplace and who have income at least as high as 100% of the federal poverty level (FPL) ($15,650 for a single adult or $32,150 for a family of four in 2026). In the past, lawfully present immigrants who made less than 100% of the federal poverty level could also receive help paying premiums and cost-sharing for coverage…

  • I heard that there have been changes to Marketplace premium tax credits and other Marketplace rules. How could these changes affect me?

    FAQs

    This FAQ was updated on January 14, 2026, to reflect the expiration of the enhanced premium tax credits. The premium tax credit enhancements that began in 2021 expired at the end of 2025 and have not been renewed by Congress. This means that many Marketplace enrollees eligible for premium tax credits will receive less financial assistance, and the amount they have to pay in monthly premiums has increased. Other Marketplace enrollees may no longer be…

  • What happens if I want to quit a Marketplace health plan during the year?

    FAQs

    It is important that you contact both the Marketplace and the health plan and let them know you no longer need coverage. Click here for details on how to terminate Marketplace coverage if you live in a HealthCare.gov state. State-based Marketplaces may have their own process for terminating coverage. Check with your state-based Marketplace for more information if you live in one of these states. Do not simply stop paying the premium for your Marketplace health plan…