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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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  • A New Way of Measuring Health Costs Sheds Light on Recent Health Spending Trends

    Issue Brief

    National health spending started to grow more rapidly recently after several years of unusually slow growth. This analysis from the Kaiser Family Foundation and the federal Bureau of Economic Analysis helps to dissect why that may be happening. Using recently-released disease-based health spending data compiled by the federal government, the analysis finds that the drivers of health spending growth shifted in the years following the Great Recession. The number of people treated for various diseases picked up,…

  • An Overview of Actions Taken by State Lawmakers Regarding the Medicaid Expansion

    Fact Sheet

    The ACA Medicaid expansion has garnered different responses from statelawmakers - Democratics and Republicans as well as governors and legislatures. While it does not cover how every state has enacted the ACA Medicaid expansion, this fact sheet highlights some of the different actions state lawmakers have taken in response to the ACA Medicaid expansion.

  • Health-Care Deductibles Climbing Out of Reach 

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman explores the trend of higher deductibles in health plans and discusses a new analysis showing that many people with insurance don’t have sufficient financial resources to pay a mid- or high-range deductible. All previous columns by Drew Altman are available online.

  • JAMA Forum: Of SCOTUS and Chicken

    Perspective

    Larry Levitt's March 2015 post explores what could happen if the U.S. Supreme Court rules for the plaintiffs in the King v. Burwell case, the lawsuit that challenges the federal government’s authority to provide financial assistance to people who buy insurance in federally-operated marketplaces created by the Affordable Care Act.

  • Open Enrollment: Insights from Medicare for Health Insurance Marketplaces

    Perspective

    This Policy Insight draws on the experiences of Medicare beneficiaries during Medicare’s annual enrollment period to consider whether consumers with health insurance coverage through the Affordable Care Act’s new marketplaces will shop for a better deal during their open enrollment season.

  • Brief Provides Update on LGBT Coverage and Health as More States Recognize Same-Sex Marriage

    News Release

    An updated issue brief from the Kaiser Family Foundation gives a detailed profile of health concerns for lesbian, gay, bisexual and transgender individuals, offers the latest demographic data, and discusses the impact of recent changes in state and federal policies on health coverage, including the Affordable Care Act and same-sex marriage. As of this month, same-sex marriage is recognized in 32 states and the District of Columbia. The brief, Health and Access to Care and…

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

    From Drew Altman

    In this 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.

  • Summary of the Affordable Care Act

    Fact Sheet

    This document summarizes the comprehensive 2010 health reform law, often called the Affordable Care Act or ACA, including changes made to it by subsequent legislation, with a focus on provisions to expand coverage, control costs, and improve delivery systems.