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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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  • Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

    Issue Brief

    Massachusetts is the first state to finalize a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test CMS's capitated financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, with enrollment beginning on April 1, 2013. Starting in 2013, CMS will implement a three-year multi-state demonstration to test new service delivery and payment models for people who are eligible for both federal health programs. Massachusetts' demonstration…

  • Making Sense of the Census Uninsured Numbers

    Event Date:
    Event

    The Alliance for Health Reform and the Kaiser Family Foundation’s Commission and Medicaid and the Uninsured discuss the Census uninsured numbers. The Census Bureau announced that the number of people without health insurance dropped from 50 million to 48.6 million in 2011, marking the first decrease since 2007. That information came from the Current Population Survey, but it isn't the only data that Census is releasing on the uninsured. The Bureau is preparing a second…

  • Medicaid and Children’s Health Insurance Program Provisions in the New Health Reform Law

    Issue Brief

    This brief compares the Medicaid and Children's Health Insurance Program provisions in the new health reform law with pre-reform law governing those programs. The analysis focuses on Medicaid coverage and financing changes; how Medicaid and CHIP will interface with a new health insurance exchange and other Medicaid benefits and access changes. Overall, the new law includes an individual requirement to obtain health insurance, a significant Medicaid expansion and subsidies to help low-income individuals buy coverage…

  • New NPR/Kaiser/Harvard Poll Examines Public’s Views of the Role of Health Care Interest Groups in the Health Care Debate

    Poll Finding

    This 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 health-related issues by NPR,…

  • How is the Affordable Care Act Leading to Changes in Medicaid Today? State Responses to Five New Options

    Issue Brief

    This policy brief examines how states in every region have responded to five key opportunities available under the health reform law to help them prepare for the significant expansion of Medicaid in 2014. The options covered in the brief include incentives for states to get an early start on the Medicaid coverage expansion; increased federal funding to upgrade Medicaid eligibility systems; money to improve care for beneficiaries with chronic conditions by providing "health home" services;…

  • Survey of Health Insurance Agents: Assessing Trends in the Individual and Small Group Insurance Markets

    Poll Finding

    This nationally representative survey of 500 health insurance agents and brokers working in the individual and small group markets explores their outlook on market trends and views on the Affordable Care Act (ACA). The survey finds that many agents are seeing steep increases in premiums and deductibles for individuals and small businesses purchasing health insurance. When asked to estimate what they expect to be the typical premium increase in 2012 based on what they have…

  • Kaiser Health Tracking Poll – June 2009

    Poll Finding

    The June Kaiser Health Tracking Poll finds remarkable stability in public opinion on health reform as Congressional committees begin to hone in on the details of their health reform bills and debate intensifies. A solid majority of the American people continue to believe that health reform is more important than ever given the country’s economic problems. A solid majority of the American people continue to believe that health reform is more important than ever given…

  • Explaining Health Reform: Medicare and the New Independent Payment Advisory Board

    Issue Brief

    This brief describes how the new board created under the 2010 health reform law is expected to limit the growth in Medicare spending over time. Starting in 2014, if projected per capita Medicare spending exceeds targets set in the law, the board must recommend ways to reduce Medicare spending, while maintaining quality and access to care for beneficiaries. The board’s recommendations automatically take effect the next year unless Congress adopts an alternative plan to achieve…

  • Health Reform Implementation: When Sausage-Making Moves Downtown

    Event Date:
    Event

    Panelists at this briefing examine what's happening behind the scenes to implement the Patient Protection and Affordable Care Act. An overview of federal policymaking and the efforts by stakeholders and others to affect final policies pertaining to the health reform law is provided. The session will look into key tools and levers available to the federal government, including formal rulemaking and other policy processes, as well as efforts by stakeholders and others to affect final…

  • Understanding The Medicaid And CHIP Maintenance of Eligibility Requirements

    Fact Sheet

    This fact sheet examines the provisions in the Patient Protection and Affordable Care Act (ACA) that require states to maintain eligibility and enrollment standards for Medicaid and the Children's Health Insurance Program. These maintenance of eligibility (MOE) provisions were designed to keep Medicaid and CHIP coverage stable until coverage expands under the health reform law. Under the MOE provisions, to receive federal Medicaid funds, states cannot impose eligibility and enrollment policies that are more restrictive…