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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.

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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  • Visualizing Health Policy: Barriers to Care Experienced by Women in the United States 

    News Release

    This Visualizing Health Policy infographic looks at barriers to care experienced by women in the United States. Women incur greater health care costs than men, particularly during the reproductive years. Despite a lower uninsured rate than men (11% vs 14%), women are more likely to skip a recommended medical test or treatment due to cost. However, cost barriers to contraception have decreased for insured women since the Affordable Care Act’s (ACA’s) coverage requirement took effect.…

  • Voters Are Tuning Out the Health Care Debates

    From Drew Altman

    In this Axios column, Drew Altman reports on new KFF focus groups with voters. They show voters are focused on the problems they have paying for care and navigating the health system, but have yet to tune in on the health proposals being made by candidates and elected officials, and don’t see them as relevant to their problems. 

  • JAMA Forum: Medicare-For-All or Medicare-For-More?

    Perspective

    In this May 2019 post for The JAMA forum, Larry Levitt examines how the early discussion and positioning among the presidential candidates offers a glimpse into how a debate about Medicare-for-all might play out.

  • Individual Market Insurers Are Expecting to Pay a Record $800 Million in Rebates to Consumers for Excessive Premiums in 2018

    News Release

    Individual market insurers are expecting to return to consumers a record total of about $800 million in excess premiums for 2018, a year in which the insurance companies posted their best annual financial performance under the Affordable Care Act to date, finds a new KFF analysis. The rebates to more than 3 million eligible individual market consumers, based on preliminary estimates by insurers, must be issued by September 30. They are the result of the…

  • The Silent Affordability Crisis Facing Sick People

    From Drew Altman

    In this Axios column, Drew Altman shows that employer coverage for lower wage workers is much worse than ACA marketplace coverage for similar populations. It’s a bigger problem we need to talk about more, he says.

  • Individual Insurance Market Performance in 2018

    Issue Brief

    Individual market insurers are expecting to return to consumers a record total of about $800 million in medical loss ratio rebates for 2018, a year in which the insurance companies posted their best annual financial performance under the Affordable Care Act to date. Financial results for 2018 suggest that insurers in the individual market are generally returning to or exceeding profitability levels seen before 2014, when ACA insurance market rules took effect, including the requirement…

  • Poll Finds Most Americans Oppose the Trump Administration’s Changes to Restrict Title X Family Planning Funds from Clinics that also Provide or Refer for Abortion

    News Release

    A new KFF poll of the public’s views on reproductive health issues finds most Americans, including majorities of women of reproductive age, are concerned that access to women’s reproductive health and preventive care services may be limited by the Trump administration’s changes to Title X, the nation’s federal family planning program. The poll examines the public’s views of major regulatory changes to the Title X program, which funds nearly 4,000 clinics nationally to pay for…

  • KFF Poll: Public Opinion and Knowledge on Reproductive Health Policy

    Poll Finding

    The latest KFF Poll examines the public’s attitudes towards different facets of reproductive health care in light of recent policy changes made by the Trump administration. This poll examines attitudes towards major changes to the Title X program and attitudes toward state-level laws restricting abortions after a fetal heartbeat has been detected. The poll also looks at public awareness of provisions related to women’s health that are part of the 2010 Affordable Care Act.