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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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  • How Many Employers Could be Affected by the Cadillac Plan Tax?

    Issue Brief

    As fall approaches, we can expect to hear more about how employers are adapting their health plans for 2016 open enrollments. One topic likely to garner a good deal of attention is how the Affordable Care Act’s high cost plan tax (HCPT), sometimes called the “Cadillac plan” tax or "Cadillac tax," is affecting employer decisions about their health benefits. The tax takes effect in 2018. The potential of facing an HCPT assessment as soon as…

  • How Primary-Care Physicians Are Handling the Influx of Newly Insured

    News Release

    In his column for The Wall Street Journal's Think Tank, Kaiser’s President Drew Altman is joined by The Commonwealth Fund's President David Blumenthal to discuss the impact of the Affordable Care Act’s coverage expansion on the primary care delivery system. Their analysis is based on the Kaiser-Commonwealth National Survey of Primary Care Providers. All previous columns by Drew Altman are available online.  

  • Few Uninsured Know Date of Pending Deadline for Obtaining Marketplace Coverage; Many Say They Will Get Coverage Soon, Though Cost is a Concern

    News Release

    Most Democrats Like Medicare-for-All, But Very Few Say the Issue Will Drive Their Votes in the 2016 Elections Similar to Last Month, More Hold Unfavorable Views of the ACA than Favorable Ones The Affordable Care Act's third open enrollment period will end on Jan. 31, but the latest Kaiser Health Tracking Poll finds that only a small share of people without health insurance realize it. Just 7 percent of the uninsured correctly identify January as…

  • Bernie Sanders, Hillary Clinton, and Medicare for All

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman explores the differing positions of presidential candidates Hillary Clinton and Bernie Sanders on a single payer or Medicare-for-all health care system and whether Democratic voters consider it an important factor in the 2016 primaries. All previous columns by Drew Altman are online.

  • Surprise Medical Bills

    Issue Brief

    This brief explores the problem of "surprise medical bills" -- charges arising when an insured individual inadvertently receives care from an out-of-network provider. It reviews studies on the extent of the issue, including Kaiser Family Foundation polling data, and outlines state and federal policy responses, including rules and proposed rules for Medicare and plans in Affordable Care Act marketplaces.

  • Did the Affordable Care Act Make Health Care More Affordable?

    Video

    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?

  • Performance Measurement Under Health Reform: Proposed Measures For Eligibility and Enrollment Systems and Key Issues and Trade-offs to Consider

    Issue Brief

    The adoption of new eligibility and enrollment requirements under the Affordable Care Act (ACA) provides states and the federal government an important opportunity to implement a meaningful set of performance measures for eligibility and enrollment systems. Performance measures could be used at the federal level to assess state performance in meeting the ACA’s eligibility and enrollment goals, while states could use measures for program management and quality improvement. This brief seeks to inform the development…