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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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  • National Health Insurance — A Brief History Of Reform Efforts In The U.S.

    Issue Brief

    This policy brief provides an overview of health reform efforts in the United States over much of the last century, from New Deal-era calls for government-subsidized health coverage to the creation of Medicare and Medicaid in the 1960s and the failed attempt at universal coverage in the early 1990s. Issue Brief (.pdf)

  • Pulling it Together: The “Third School” for Controlling Health Care Costs?

    Perspective

    For as long as I have been in the field, there have been two dominant schools of thought about how to control health care costs. One school, The Regulators, believed that the best way to slow increasing costs was to control the total resources going into the health care system: putting limits on the supply of medical professionals, technology and facilities; setting payment rates; or putting enough purchasing power in the hands of government to…

  • Pulling it Together: The Most Popular Provision in the ACA?

    Perspective

    In our most recent monthly tracking poll, we asked the American people what elements of the health reform law they like and dislike. Surprisingly, the runaway favorite was a relatively obscure requirement that health plans provide consumers with a short, easy to understand description of their benefits and coverage. Sixty percent of the American people gave this requirement for greater transparency in health insurance benefits a very favorable rating, the only provision in the law…

  • Explaining Health Care Reform: How Might a Reform Plan Be Financed?

    Issue Brief

    One of the key challenges in enacting a health care reform plan is how to finance it among government, employers, and individuals. Of particular concern to policymakers is what effect a health reform plan would have on government spending and the federal budget. President Obama and Congressional leaders have said that any health reform plan should not add to the budget deficit over a 10 year period. This brief explains the likely sources of added…

  • 10 FAQs: Medicare’s Role in End-of-Life Care

    Fact Sheet

    About eight of 10 of the 2.6 million people who died in the US in 2014 were people on Medicare, making Medicare the largest insurer of health care provided during the last year of life. These Frequently Asked Questions explain Medicare’s role in or coverage of end-of-life care, advance care planning, advance directives, and hospice care. They also provide information on Medicare spending on end-of-life care, changes to the physician fee schedule, and how related issues arose…

  • Poll Finds Nearly Three Quarters of Americans Say Prescription Drug Costs Are Unreasonable, and Most Blame Drug Makers Rather Than Insurers for the Problem

    News Release

    If Supreme Court's King v. Burwell Decision Restricts Insurance Subsidies to Certain States, Most Say Congress Should Act to Ensure Residents of All States are Eligible, and a Majority in Potentially Affected States say Their State Should Act Public's Views on Affordable Care Act Are Divided and Unchanged: 42% Unfavorable and 39% Favorable Nearly three quarters (73%) of the public view prescription drug costs as unreasonable, and far more blame pharmaceutical companies more than insurers…

  • Medicare Spending Cuts and Hospital Productivity Gains

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman and guest co-author Dana Goldman examine hospital productivity gains, and what they may mean for hospitals’ ability to absorb spending reductions.

  • The Coverage Provisions in the Affordable Care Act: An Update

    Issue Brief

    This brief examines the coverage provisions of the Affordable Care Act , providing an update on how they have been implemented and assessing their impact five years after the law's enactment. It also discusses key issues for coverage going forward.