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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

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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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  • Pulling it Together: How the ACA Can Help The Homeless

    From Drew Altman

    Estimates are that there are approximately 630,000 people who are homeless on any given night in the U.S. -- about two-thirds in shelters and one-third on the street or without real shelter. Several million people are estimated to experience homelessness over the course of a year. About two-thirds are individuals and the balance are in families. These numbers are virtually identical to national estimates we used when I worked intensively on the issue of homelessness in the…

  • Explaining the State Integrated Care and Financial Alignment Demonstrations for Dual Eligible Beneficiaries

    Issue Brief

    This paper provides an overview of the joint efforts of states and the Centers for Medicare and Medicaid Services (CMS) to develop more integrated ways of paying for and delivering health care to the 9 million people who are eligible for both the Medicare and Medicaid programs. Dual eligible beneficiaries comprise many of the poorest and sickest people covered by either program, and they account for a disproportionately large share of Medicare and Medicaid spending.…

  • Pulling it Together from Drew Altman: Multiple Agendas for Controlling Health Care Costs

    Perspective

    In what would be a domestic policy trifecta, we may be headed for interconnected big debates about economic recovery, entitlement programs and health reform. A core issue in the entitlement and health reform debates is the problem of rising health care costs. President Obama, now apparently fully briefed on the economic, budget and health reform realities he faces, is talking conspicuously about hard choices that may lie ahead. In a short period of time the…

  • Pulling it Together: The Health Care Industry’s Second Voluntary Effort

    Perspective

    The announcement that health care industry groups plan to put on the table voluntarily a package of proposals to shave $2 trillion off the rate of increase in health spending over the next ten years immediately conjures up the image of the Voluntary Effort or VE launched with similar fanfare in the Carter administration.  Back then the industry used the VE to fend off Jimmy Carter's efforts to aggressively control the costs of hospital care…

  • In Depth Analysis of Health Reform Issues

    Report

    These reports provide in-depth analysis related to the health reform debate. Additional reports will be added as they become available. Medicaid Expansion in Health Reform: National and State Estimates of Coverage and CostsThis analysis and public briefing examine the potential national and state-by-state impacts on Medicaid enrollment and spending of the expansion of coverage for low-income adults under the health reform law. Reform Calculator Estimates Premiums and Subsidies Available In 2014The Foundation's interactive health reform…

  • Rural Health: Laying the Foundation for Health Reform

    Event Date:
    Event

    The Alliance for Health Reform and the Robert Wood Johnson Foundation co-sponsored this briefing to have a panel of experts answer questions about how some aspects of pending health reform proposals may have a substantial impact on rural care. What provisions in the various reform proposals affect rural health care? What particular challenges need to be overcome in order to improve care delivery in rural areas? What aspects of health reform will require special accommodation…

  • Pulling It Together: Implementation Is Forever

    Perspective

    Now that historic health reform legislation is law, everyone is rightfully focused on implementation. There are two very different ways to look at implementation. One is the more legalistic worm's eye view, which sees implementation largely as the process of putting into effect what was written in the law. In the worm's eye view implementation proceeds in a linear fashion from legislation, to regulations specifying what the statute calls for in greater detail, to operations…

  • Pulling It Together: Uninsured But Not Yet Informed

    Perspective

    If there is one thing there is general agreement on when it comes to the Affordable Care Act (ACA) it’s that it will help the uninsured.  The estimates are that 32 million people will gain coverage under the law through an expansion of Medicaid and tax credits, which will help low- and moderate-income people purchase coverage through the new insurance exchanges. Therefore, it was a real surprise in our latest tracking poll to learn that…

  • 2008 Election Briefs

    Poll Finding

    Health care remains among the top three election issues voters want to hear the presidential candidates discuss. Kaiser's new series of election briefs frame the challenges the heath care system faces, provide basic facts, and offer questions to assess the presidential candidates' plans on key health policy issues. Check back for more issue briefs.  Eliminating Racial/Ethnic Disparities in Health Care: What are the Options  Health Care Costs and Election 2008  Women's Health and Election 2008…

  • How Will The Uninsured Be Affected By Health Reform?

    Issue Brief

    This brief examines who the uninsured are and explores how they could be affected by health reform, including estimates of how many might qualify for coverage under a Medicaid expansion, how many would be eligible for subsidies and how many would not be eligible for such help. Issue Brief (.pdf)