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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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  • The ACA and People with HIV: An Update

    Issue Brief

    This report provides a second look at how the Affordable Care Act (ACA) is impacting people with HIV two years into these new coverage opportunities, based on focus groups conducted with HIV positive individuals from five states in early 2016, after the third round of open enrollment. Groups were conducted with HIV positive individuals who gained insurance coverage – through either the Marketplaces or Medicaid expansion- in California and New York and with those who…

  • New Chart Collection Examines the Public’s Malleable Views Around a National Health Plan and Expanding Access to Medicare

    News Release

    For many years, the Kaiser Family Foundation has been tracking public opinion on the idea of national health plan. Since the 2016 Democratic presidential primary and Sen. Bernie Sanders’ rallying cry for “Medicare-for-all,” our polls have shown a modest increase in support for the idea of a national health plan, and broad support for proposals that expand Medicare. At the same time, our polls also show that support can quickly erode when people hear further…

  • State-by-State Estimates of Changes in Federal Spending on Health Care Under the Graham-Cassidy Bill

    Issue Brief

    A new health care bill recently introduced by a number of senators led by Senators Lindsey Graham and Bill Cassidy would repeal major elements of the Affordable Care Act (ACA), make changes to other ACA provisions, and fundamentally alter federal Medicaid financing. In this brief, we estimate changes in federal funding due to the new block grant program and the Medicaid per enrollee cap on a state-by-state basis under the Graham-Cassidy bill relative to current…

  • “Partial” Medicaid Expansions Could Limit States’ Spending But Cover Fewer People at a Higher Federal Cost Compared to Traditional ACA Expansions

    News Release

    If states were able to receive enhanced Affordable Care Act matching funds for “partial” expansions of Medicaid, fewer people would get health coverage and the federal government would spend more, compared to a traditional expansion under the law, KFF explains in a new brief. The explainer describes how a partial expansion would differ from a traditional ACA Medicaid expansion and summarizes some of the expected effects. It also documents which states have sought federal approval…

  • How Affordable are 2019 ACA Premiums for Middle-Income People?

    Issue Brief

    This analysis finds that Affordable Care Act marketplace premiums are least affordable for older adults who earn too much to qualify for federal subsidies, especially those living in rural areas where premiums are highest. The analysis also discusses a variety of state and federal proposals that seek to lower premiums for middle-class people buying their own insurance who are ineligible for ACA subsidies.

  • Expanding Medicaid to Low-Income Childless Adults Under Health Reform: Key Lessons From State Experiences

    Issue Brief

    The health reform law will expand Medicaid to millions of low-income adults, including many childless adults who have historically been ineligible for the program, necessitating one of the largest enrollment efforts in the program's history. This report, based on interviews with officials in seven states and the District of Columbia and national experts, examines lessons learned from past state experience covering childless adults through waiver and state-funded programs and profiles the programs included in the…

  • Public Reporting of Quality Outcomes: What’s the Best Path Forward?

    Event Date:
    Event

    The Affordable Care Act aims to promote higher quality care in part by rewarding – and eventually requiring – the reporting of certain quality measures. Previous efforts suggest that public reporting can add significant value. Yet there are concerns about the best way to measure outcomes and quality, the possible unintended effects of public reporting, and whether purchasers and consumers actually use the information to make choices. Panelists at this April 27 briefing co-sponsored by…

  • Peering Into the Black Box of Insurance Rating

    Perspective

    Recently, the New York Times reported that private health insurers continue to seek large premium increases despite seeing lower than expected use of medical care and booking record profits. The story highlights a significant problem for health policy: the lack of good, public information about how health insurers manage health care use and what they pay for medical services. As a nation, we rely on competition among largely private health plans to ensure that health…