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Affordable Care Act Signups Are Down, But Still an Incomplete Picture

Data from CMS may not fully show how much the expiration of the enhanced premium tax credits has affected enrollment in the ACA Marketplaces. The extent of enrollment changes likely won’t be known until this summer, when effectuated enrollment data are typically released.
DATA

Marketplace Enrollment Snapshot for Open Enrollment 2026

ANALYSIS

Higher Premium Payments or Higher Deductibles: The ACA's Tradeoffs

QUIZ

Test Your Knowledge of the Affordable Care Act

ANALYSIS

Competition Increased in Individual Market But Fell in Fully Insured Group Markets

Enhanced Premium tax credits

2025 KFF Marketplace Enrollees Survey

If their premium payments double, about one in three ACA enrollees say they would be “very likely” to look for a lower-premium Marketplace plan.

Updated Larry QT on ePTCs

There is No Drop-Dead Date for an ACA Tax Credit Extension, But Coverage Losses Will Mount as the Clock Ticks

A discharge petition in the House paves the way for a vote on a three-year extension of the tax credits, which would provide ACA enrollees premium relief whenever it comes. While there is still time to extend the enhanced tax credits, with each passing day, more and more ACA Marketplace enrollees are going to drop their health insurance when faced with eye-popping increases in their premium payments, writes KFF’s Larry Levitt.

Timely insights and analysis from KFF staff

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  • Potential Story Lines from Trump-Era Health Care Cuts

    Perspective

    In his latest column for the JAMA Health Forum, KFF’s Larry Levitt talks about how popular shows like “The Pitt” can make changes to the health care system stemming from this year’s federal tax and budget bill tangible for viewers, and offers some suggested story lines.

  • About Half of Adults with ACA Marketplace Coverage are Small Business Owners, Employees, or Self-Employed

    Issue Brief

    This analysis estimates that 48% of adults under age 65 with individual market coverage are either employed by a small business with fewer than 25 workers, self-employed entrepreneurs, or small business owners. Because the vast majority of this coverage is purchased through the Affordable Care Act (ACA) Marketplaces, changes to the ACA, including the expiration of the enhanced premium tax credits at the end of this year, would have significant implications for what small business owners and workers spend on their health care.

  • How Will the 2025 Reconciliation Law Affect the Uninsured Rate in Each State?

    Issue Brief

    This analysis apportions the increase in the number of uninsured across the 50 states and DC. CBO estimates that the reconciliation law will increase the number of uninsured by 10M in 2034 and rise to over 14M if enhanced premium tax credits for ACA Marketplace enrollees expire later this year.

  • State-Based Efforts Will Provide Limited Relief from Enhanced Tax Credit Expiration

    Policy Watch

    After failed Senate votes late last year and no subsequent bipartisan agreement, the enhanced premium tax credits expired as of January 1. Some states, particularly those operating State-Based Marketplaces (SBMs), have been preparing for this possibility for months and are moving to blunt the impact on consumers by implementing their own state-funded subsidies and implementing other programs aimed at stabilizing the cost of unsubsidized premiums.

  • How Unaffordable is Health Care?

    Perspective

    In his latest JAMA Forum column, KFF’s Larry Levitt explores how unaffordable health care is in the U.S. in the context of the debate over extending enhanced Affordable Care Act premium tax credits and an upcoming election where affordability will likely be front and center.

  • Policy Changes Bring Renewed Focus on High-Deductible Health Plans 

    Issue Brief

    Policy changes, anticipated increases in premium costs for enrollees, and new standards for health savings accounts may encourage consumers to seek out plans with lower premiums but higher deductibles. This issue brief explores the features of bronze and catastrophic plans, coverage and costs, and the complicated choices consumers face.