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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

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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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  • Optimizing Medicaid Enrollment: Spotlight on Technology – Using Schools and Data Matching to Enroll Kids in Medicaid and CHIP

    Issue Brief

    This brief examines efforts by the Chicago Public School system to use multiple strategies including data matching with the school lunch program, marketing and local organizing to target children for outreach and enrollment in public health insurance and other benefits. It is the third brief in a Spotlight on Technology series profiling several states' innovative applications of technology to Medicaid enrollment efforts. The series illustrates a range of approaches that states can adopt to improve…

  • State Exchange Profiles: Nebraska

    Other Post

    Final update made on December 19, 2013 (no further updates will be made) Establishing the Exchange On November 15, 2012, Governor Dave Heineman (R) announced that Nebraska would not establish a health insurance exchange.1Earlier in 2012, the Nebraska legislature introduced two bills (LB 835 and LB 838) to establish a health insurance exchange in Nebraska, however both failed when the legislative session concluded in April.2,3 In 2011, Governor Heineman signed LB 22 into law, which…

  • State Marketplace Profiles: Michigan

    Other Post

    Final update made on November 26, 2013 (no further updates will be made) Establishing the Marketplace While Governor Rick Snyder (R) supports the creation of a State-based Marketplace, he acknowledged on November 16, 2012, that without authorizing legislation, he would plan for a State-federal Partnership Marketplace.1  The state began moving in the direction of a partnership in August 2012 due to legislative opposition that left the state unable to meet the federal timetable for implementation.2  Michigan will…

  • State Exchange Profiles: Kansas

    Other Post

    Final update made on March 21, 2013 (no further updates will be made) Establishing the Exchange After placing health insurance exchange planning on hold until after the November elections, Governor Sam Brownback (R) announced on November 9, 2012, Kansas would default to a federally-facilitated exchange.1,2 With the initial endorsement of the Governor in 2011, Kansas Insurance Commissioner Sandy Praeger, had established eight exchange planning work groups comprised of hundreds of volunteers across civic groups, government…

  • State Marketplace Profiles: Colorado

    Other Post

    Final update made on November 8, 2013 (no further updates will be made)  Establishing the Marketplace On June 1, 2011, Governor John Hickenlooper (D) signed SB 11-200 into law, establishing the Colorado Health Benefit Exchange.1  In January 2013, the Exchange announced that the online Marketplace would be called Connect for Health Colorado (C4HCO). Structure: The legislation defines Colorado’s Marketplace as a quasi-governmental organization, specifically a "nonprofit unincorporated public entity." Governance: The Marketplace is governed by a 12-member board.…

  • State Exchange Profiles: Alaska

    Other Post

    Final update made on December 4, 2012 (no further updates will be made)  Establishing the Exchange On July 17, 2012, Governor Sean Parnell (R) announced that Alaska will not create a state-run health insurance exchange, and instead will allow the federal government to operate an exchange in the state.1 While a bill establishing an exchange was introduced in the 2011 legislative session and reconsidered in 2012, it failed to pass. Prior to the announcement that the…

  • State Exchange Profiles: Arizona

    Other Post

    Final update made on December 4, 2012 (no further updates will be made) Establishing the Exchange  On November 28, 2012, Governor Jan Brewer (R) informed federal officials that Arizona would default to a federally-facilitated health insurance exchange.1 Prior to her decision to default, the Governor had established the Office of Health Insurance Exchange to “organize the health insurance marketplace for easier evaluation by individuals and small businesses to acquire affordable health insurance.”2 While legislation establishing a…

  • KFF/Harvard Survey on Public’s Health Care Agenda for the 112th Congress Finds An Uptick in Public Opposition to Health Reform As GOP Ramped Up Repeal Campaign

    Perspective

    Though the public remains divided on health reform overall, according to a new survey jointly conducted by the Kaiser Family Foundation and Harvard School of Public Health, opposition to the new law ticked upward in January from 41 percent to 50 percent as Republicans ramped up efforts to repeal it. The survey also showed that there is no groundswell of public support for overturning the law, with 47 percent wanting to either expand the law…

  • Kaiser November Tracking Poll Finds Health Care a Factor in Congressional Election, But Not a Dominant One

    Perspective

    This month’s Kaiser Health Tracking Poll, conducted during the four days following the mid-term election, asked voters in an open-ended question to name in their own words the biggest factors influencing their vote for Congress, and found that health care was a factor, but not a dominant one. Among all voters, the factor mentioned most often was the economy/jobs (29%). The next two most mentioned factors were party preference (25%) and views of the candidates…

  • Health Affairs Issue Focuses on Health Reform

    Perspective

    The June 2010 issue of the journal Health Affairs is dedicated to health reform, and "begins to tackle the hundreds of implementation issues inherent in health reform and offers prescriptions for averting trouble," according to Editor-in-Chief Susan Dentzer. The issue features an article by Kaiser researchers examining past and present polling related to reform and showing how a surprisingly stable public opinion tracked with historic patterns, even if the contentious public debate suggested a volatile…