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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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  • New Analysis Shows States with Medicaid Expansion Experienced Declines in Uninsured Hospital Discharges

    Issue Brief

    Expanded health insurance coverage through the Affordable Care Act (ACA) is having a major impact on hospital payer mix across the country. Similar to other reports recently released, new data examining hospital discharges in 16 states with data through the second quarter in 2014 show increases in Medicaid and declines in uninsured or self-pay discharges in states that implemented the Medicaid expansion. These trends hold true for all hospital discharges as well as for specific…

  • Nearly Half of the Uninsured, or 15.7 Million People, Are Eligible for Medicaid or Subsidized Affordable Care Act Coverage, Analysis Finds

    News Release

    State-Level Numbers Provide Estimates of How Many Could Be Reached During Third ACA Open Enrollment Period Weeks away from the Affordable Care Act’s third open enrollment period, a new Kaiser Family Foundation analysis finds nearly half (49% or 15.7 million) of the 32.3 million nonelderly people in the United States without health insurance at the beginning of 2015 are eligible for Medicaid or subsidized coverage through an ACA marketplace. On a state level, the share…

  • GOP Views of Medicaid Expansion Differ From Conventional Wisdom

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman examines Republican attitudes on Medicaid expansion in light of last night’s election of Republican Matt Bevin as Kentucky’s next governor. All previous columns by Drew Altman are available online.  

  • The COBRA Subsidy and Health Insurance for the Unemployed

    Issue Brief

    With the nation's unemployment rate rising to its highest levels in decades as a result of the recession, many families have lost their employer-sponsored health coverage or are at risk of doing so. In an effort to help people maintain coverage after a layoff, the stimulus legislation known as the American Recovery and Reinvestment Act of 2009 provides temporary subsidies to some workers so that they can maintain their previous employer-sponsored coverage through COBRA after…

  • Medicaid and Community Health Centers: The Relationship Between Coverage for Adults and Primary Care Capacity in Medically Underserved Communities

    Issue Brief

    Community health centers play an important role in providing care to uninsured and low-income individuals living in medically underserved communities. They rely on many different revenue sources and, over time, Medicaid has become a central source of funding for most health centers. To better understand how Medicaid influences health center practice, this paper compares the strength of health centers in states that have expanded Medicaid coverage for adults to health centers states with more limited…

  • Health Insurance Exchanges: Can States and the Federal Government Meet the Deadline?

    Event Date:
    Event

    The Alliance for Health Reform and the Commonwealth Fund sponsor a July 27 briefing to discuss how states are facing implementation and evaluation deadlines in regards to health insurance exchanges. Speakers will explore such questions as: What needs to happen between now and January 2014 for states to successfully implement exchanges and other aspects of health reform? What are options for states if they fail to meet the upcoming November deadline for declaring their exchange…

  • Explaining Health Care Reform: Key Changes to the Medicare Part D Drug Benefit Coverage Gap

    Issue Brief

    On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. The health reform law, as modified by the Health Care and Education Reconciliation Act of 2010 which passed the House of Representatives on March 21, 2010 and is under consideration in the Senate, makes several key changes to the Medicare Part D drug benefit to reduce Part D enrollees’ out-of-pocket liability when they reach the coverage gap, known as…

  • Uncompensated Care for the Uninsured in 2013: A Detailed Examination

    Report

    This report provides estimates of spending for uncompensated care, in 2013, just before implementation of health reform’s major coverage provisions. The report estimates the amount of uncompensated care provided, analyzes the site of care for uncompensated services, and details sources of funding for uncompensated care. These estimates provide an important baseline against which to measure major changes that are occurring under the ACA.

  • Kaiser Family Foundation Launches New Non-Profit Health Policy News Service

    News Release

    Kaiser Health News Will Provide In-Depth Reporting on Major Health Policy Issues Menlo Park, CA -- In the midst of a major federal health reform debate and the ongoing financial turmoil in the media industry, the Kaiser Family Foundation officially launched Kaiser Health News (KHN) today to provide a new source of in-depth reporting on major health issues. KHN is staffed by experienced health policy journalists and editors, and will feature contributions from a wide…