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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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  • Medicaid: What to Watch in 2018 from the Administration, Congress, and the States

    Issue Brief

    Medicaid provides health insurance coverage for about one in five Americans and is the largest payer for long-term care services in the community and nursing homes. Efforts in 2017 to repeal and replace the Affordable Care Act (ACA) and cap federal financing for Medicaid were unsuccessful but help to set the stage for 2018. As 2018 begins, there is a focus on administrative actions using Medicaid Section 1115 demonstration waivers, state actions on Medicaid expansion,…

  • The Trump Administration’s Hidden Attacks on the Affordable Care Act

    Perspective

    In a Washington Post op-ed, “The Trump administration’s hidden attacks on the Affordable Care Act,” Larry Levitt discusses the latest proposed regulations by the Trump administration to expand association health plans: changes that could wound the ACA insurance marketplace, but are unlikely to make it collapse.

  • ACA Mandate Repeal May Be Less Popular Than GOP Thinks

    From Drew Altman

    In this Axios column, Drew Altman discusses how public opinion seems to flip on eliminating the individual mandate as part of the tax legislation, from for it to against, when the public considers the consequences.

  • How Premiums Are Changing In 2018

    Issue Brief

    Maps illustrate how premiums in Affordable Care Act (ACA) marketplaces changed for 2018 by looking at the change in the lowest-cost bronze, silver and gold plans by county; counties where an individual’s tax credit covers the full premium of the lowest-cost bronze plan; and counties where the unsubsidized premium for the lowest-cost gold plan has a lower or comparable premium to the lowest-cost silver plan in 2018.

  • JAMA Forum: The Health Care Law that Continues to Escape Death

    Perspective

    In this November 2017 post for The JAMA Forum, Larry Levitt reviews the status of the Affordable Care Act following actions by the Trump administration widely perceived as designed to undermine the marketplaces. Despite assertions to the contrary, Levitt finds, "at least for now, the ACA seems very much alive."

  • Kaiser Health Tracking Poll – November 2017: The Politics of Health Insurance Coverage, ACA Open Enrollment

    Feature

    This month marks the start of the ACA's fifth open enrollment period and finds three in ten of the public saying they haven't heard anything at all about the current open enrollment period. Despite their overall views of the ACA, the majority of the public (61 percent) – including most Democrats (71 percent), independents (58 percent), and half of Republicans (52 percent) – say that because President Trump and Republicans in Congress are now in…

  • Poll: Half of the Public Would Blame the Trump Administration if Fewer People Enroll in Marketplace Plans This Year, and Most See President Trump and Republicans As Responsible for the ACA‘s Future 

    News Release

    Majorities of Democrats, Independents and Republicans Would Support Allowing People Younger Than Age 65 to Buy into Medicare Half (50%) of the public would say that if fewer people sign up for marketplace plans during this year’s open enrollment, it is mainly due to the Trump Administration, and most Americans (61%) see President Trump and Republicans as responsible for the Affordable Care Act’s future, the latest Kaiser Family Foundation poll finds. While the public generally…