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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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  • Snapshots: Health Benefit Offer Rates and Employee Earnings

    Issue Brief

    Employer-provided health insurance is the primary source of insurance coverage in the United States, covering almost 160 million people.1 About 90 percent of the non-elderly privately-insured population is covered by employer-sponsored plans, meaning that employer decisions about whether to offer health benefits will influence overall rates of insurance coverage in the United States.  Sixty-nine percent of all firms offered health benefits to their employees in 2010.2 It is well-known that highly-paid workers are more likely to…

  • Health Insurance Exchange Development: Innovation in the States

    Event Date:
    Event

    Under health reform, state-based health insurance exchanges are a mechanism to buy private insurance beginning in 2014. Through panel discussions with state leaders and stakeholders, this briefing, jointly sponsored by the Bipartisan Policy Center (BPC), the Kaiser Family Foundation and the University of Virginia's Batten School of Leadership, explored states’ progress on the exchanges and identified next steps. Agenda (.pdf) Speaker Biographies (.pdf)

  • Washington’s Managed FFS Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

    Issue Brief

    Washington is the first state to sign a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test a managed fee-for-service (FFS) financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, beginning on April 1, 2013. Washington’s managed FFS demonstration uses Medicaid health home services to coordinate care for high risk/high cost dual eligible beneficiaries with chronic conditions. This policy brief summarizes key aspects of the…

  • Health Affairs Article: Florida’s Medicaid Reform: Informed Consumer Choice?

    Report

    Health Affairs Article: Florida's Medicaid Reform: Informed Consumer Choice? Florida's Medicaid reform program aims to encourage consumer choice and market competition by giving health plans new authority to vary benefits and having enrollees choose among the different plans. However, about three in 10 enrollees were not aware that they needed to make this health plan choice and over half of those who were aware reported difficulty making a plan choice, according to a Health Affairs…

  • Ask the Experts About Reform: Where Are We Now and Where Are We Headed?

    Event Date:
    Event

    The Alliance for Health Reform and Eli Lilly co-sponsored this briefing to have an expanded panel of prominent experts answer questions about the current health reform efforts.Questions addressed include: What is the status of major reform bills? How do they differ from each other, and from the plan that may emerge from the Senate Finance Committee? What are some of the outstanding issues that will need to be decided to get a bill to the…

  • Today’s Topics In Health Disparities: Is the Health Care System Ready for Health Reform?

    Event Date:
    Event

    On Wednesday, November 4, at 1 p.m. ET, this Today's Topics In Health Disparities live webcast examined how ready the health care system is for the influx of newly covered individuals that health reform aims to deliver. In the health care proposals being considered by Congress, changes to Medicaid alone could mean as many as 15 million people would become newly eligible for the program and many live in medically underserved areas. The program will…

  • Matching Health Benefit Packages to Health Needs: Key Issues To Consider In Health Reform

    Event Date:
    Event

    Three reports and a video collectively examine the range of health care needs and costs that people face today against the backdrop of the scope of health coverage that may be available to them under health reform. Children and Health Care Reform: Assuring Coverage That Meets Their Health Care Needs and Individuals With Special Needs and Health Reform: Adequacy of Health Insurance Coverage examine the needs of children and adults, respectively, focusing on those with…

  • Medicaid Long-Term Services and Supports: Key Changes in the Health Reform Law

    Issue Brief

    This issue brief examines new opportunities under the health reform law for states to balance their Medicaid long-term care delivery systems by expanding access to Medicaid home and community-based services (HCBS) programs. The brief outlines key provisions of the new law that expand HCBS benefit options, broaden financial and functional eligibility criteria, and provide additional financial incentives for states to further shift their Medicaid long-term services budgets to non-institutional settings. Issue Brief (.pdf)

  • Physician Workforce: The Next Generation

    Event Date:
    Event

    The new health reform law poses questions about how the increase in the insured population will affect the demand on the health care workforce. Will it increase the shortage among primary care physicians? What about specialists? How much of the workforce shortage can be alleviated by payment incentives in the new law for both primary care and general surgery, and other new incentives to practice in underserved areas? Are there enough effective efforts in place…

  • Survey on the Role of Health Care Interest Groups –Toplines

    Poll Finding

    These toplines are of a survey conducted jointly by NPR, the Kaiser Family Foundation, and the Harvard School of Public Health examines the public’s views and opinions of the role of health care interest groups in the ongoing federal health care debate. The survey examines whether people feel their views are represented in the ongoing legislative process and their level of trust in different groups. The survey is part of a series of projects about…