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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

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 Details Impact on Residents in Different States If the U.S. Supreme Court Rules for Challengers in King v. Burwell

    News Release

    The U.S. Supreme Court is expected to rule this month in the King v. Burwell case that challenges whether low- and moderate-income Americans are eligible for subsidies to help pay for insurance if they live in states where the federal government, rather than the state, established its new insurance marketplace under the Affordable Care Act (ACA). Using 2015 enrollment data released today, a new Kaiser Family Foundation analysis and interactive map breaks out how residents…

  • New Evidence Health Spending Is Growing Faster Again

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses new Census Department survey data showing higher health spending growth over the last four economic quarters, and raises the question: is the health spending slowdown over?

  • The ACA and People with HIV: Profiles from the Field

    News Release

    New in-depth profiles of 12 people with HIV highlight how the Affordable Care Act’s coverage expansions impacted their access to coverage and care. While some experienced serious bumps along the way, those who gained coverage through Medicaid and the Marketplaces were largely able to meet both their HIV and non-HIV care needs. At the same time, the Ryan White HIV/AIDS Program continued to play a role in HIV care and coverage, both for those who remained…

  • Poll Finds Nearly Three Quarters of Americans Say Prescription Drug Costs Are Unreasonable, and Most Blame Drug Makers Rather Than Insurers for the Problem

    News Release

    If Supreme Court's King v. Burwell Decision Restricts Insurance Subsidies to Certain States, Most Say Congress Should Act to Ensure Residents of All States are Eligible, and a Majority in Potentially Affected States say Their State Should Act Public's Views on Affordable Care Act Are Divided and Unchanged: 42% Unfavorable and 39% Favorable Nearly three quarters (73%) of the public view prescription drug costs as unreasonable, and far more blame pharmaceutical companies more than insurers…

  • What a Break in the Obamacare Battles Could Bring

    From Drew Altman

    Following the Supreme Court’s King v. Burwell decision, the Affordable Care Act could use a break from the intense political heat, though it may not get a long one as the 2016 election season heats up and presidential candidates play to their bases on health care, writes Drew Altman in his latest column for The Wall Street Journal’s Think Tank.

  • Measles Outbreak and Vaccination Debate Capture Public’s Attention

    News Release

    Those Following Measles Story More Likely To Say They Worry About the DiseaseThe public paid more attention to news coverage of the measles outbreak in the U.S. and the resulting debate on whether vaccinations should be required for all kids than any other news story included in this month's Kaiser Health Policy News Index. A total of 70 percent of Americans say they closely followed the measles story, more than say the same about the…

  • At Tax Time, No Public Backlash Over Obamacare’s Individual Mandate

    News Release

    As tax season closes, Drew Altman looks at why the ACA’s individual mandate and tax credit reconciliation process “passed their first major hurdles this tax season with no significant public backlash,” in his latest column for The Wall Street Journal's Think Tank.

  • Evolving Picture of Nine Safety-Net Hospitals: Implications of the ACA and Other Strategies

    Issue Brief

    Safety-net hospitals are an integral part of the U.S. health care landscape, providing care to some of the nation’s most medically vulnerable populations, including Medicaid enrollees and the uninsured. With the implementation of the Affordable Care Act (ACA), the U.S. health care system is rapidly changing, and safety-net hospitals need to make major adjustments to survive in the post-reform environment. This brief draws on interviews with executives at nine safety-net hospital systems and examines how…

  • Minimum Contraceptive Coverage Requirements Clarified by HHS Guidance

    Issue Brief

    New HHS clarification on ACA contraceptive coverage requirement specifies that insurance plans must cover at no cost to women all of the 18 contraceptive methods approved by the FDA.  If a provider recommends a specific option or product, plans must cover it at no cost as well. Minimum Contraceptive Coverage Requirements Clarified by HHS GuidanceContraceptive MethodProducts/OptionsMust CoverSurgical sterilizationAlso called tubal ligation√Implant sterilizationOnly Essure available√Implantable RodMultiple√ at least 1IUD - CopperOnly ParaGard available√IUD - ProgestinMultiple√ at least 1InjectionMultiple√ at…

  • The Connection Between Health Coverage and Income Security

    From Drew Altman

    In this column in The Wall Street Journal's Think Tank, Drew Altman shows how expanding health coverage and improving economic security for working Americans are connected even though they are often part of separate policy debates.