Home Affordable Care Act Topics

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?

Latest News

More KFF Health News

Stay informed.

Get KFF's latest on the Affordable Care Act

Stay informed.

Get KFF's
latest on the Affordable
Care Act

View the Latest: Affordable Care Act

Filter

List Grid

1,121-1,130 of 2,788 results

  • Explaining Cost-Sharing Reductions and Silver Loading in ACA Marketplaces

    Policy Watch

    The House of Representatives recently passed a budget reconciliation bill that would appropriate funding for cost-sharing reductions that insurers are required to provide to low-income enrollees in the Affordable Care Act marketplace. This policy watch explains what these cost-sharing reductions are, how they relate to federal spending, and what effect appropriating funding might have on premiums and the uninsured rate.

  • State Marketplace Profiles: Massachusetts

    Other Post

    Final update made on September 29, 2013 (no further updates will be made) Establishing the Marketplace On April 12, 2006, former Governor Mitt Romney (R) signed into law comprehensive health reform legislation designed to provide near-universal health coverage for state residents.1  The Massachusetts health reform law became the model for national health reform. An important component of the law was the creation of the Massachusetts Health Connector, a health insurance marketplace that manages several coverage programs.…

  • State Exchange Profiles: Tennessee

    Other Post

    Final update made on December 10, 2012 (no further updates will be made) Establishing the Exchange On December 10, 2012, Governor Bill Haslam (R) announced Tennessee would default to a federally-facilitated health insurance exchange.1 Prior to the announcement that the state would not operate its own exchange, the Tennessee Department of Finance and Administration established the Insurance Exchange Planning Initiative to advise the Governor and Legislature on exchange implementation. The Initiative worked closely with a…

  • State Exchange Profiles: Ohio

    Other Post

    Final update made on March 25, 2013 (no further updates will be made) Establishing the Exchange On November 16, 2012, Governor John Kasich (R) notified federal officials that Ohio would default to a federally-facilitated exchange; however, the state would maintain regulatory control over its insurance industry.1 The Governor also indicated Ohio would maintain control over Medicaid eligibility determinations. Prior to the announcement, the Department of Insurance in collaboration with other stakeholder agencies solicited subcontractors’ assistance for…

  • State Exchange Profiles: Kansas

    Other Post

    Final update made on March 21, 2013 (no further updates will be made) Establishing the Exchange After placing health insurance exchange planning on hold until after the November elections, Governor Sam Brownback (R) announced on November 9, 2012, Kansas would default to a federally-facilitated exchange.1,2 With the initial endorsement of the Governor in 2011, Kansas Insurance Commissioner Sandy Praeger, had established eight exchange planning work groups comprised of hundreds of volunteers across civic groups, government…

  • State Marketplace Profiles: Hawaii

    Other Post

    Final update made on November 6, 2013 (no further updates will be made)  Establishing the Marketplace On July 11, 2011, Governor Neil Abercrombie (D) signed SB 1348 into law establishing the Hawaii Health Connector, a State-based health insurance Marketplace.1  The law builds on Hawaii’s Prepaid Health Care Act of 1975 (PHCA) which required nearly all employers to provide health insurance to employees working 20 or more hours a week for four consecutive weeks.2  Structure: The legislation established the…

  • State Marketplace Profiles: Arkansas

    Other Post

    Final update made on October 29, 2013 (no further updates will be made) Establishing the Marketplace On December 12, 2012, Governor Mike Beebe (D) informed federal officials that Arkansas would pursue a state-federal partnership health insurance Marketplace (also referred to as exchange).1  A state opting for a partnership Marketplace can choose to operate plan management functions, consumer assistance functions, or both. A state can also elect to perform Medicaid and Children’s Health Insurance Program (CHIP)…

  • State Exchange Profiles: Arizona

    Other Post

    Final update made on December 4, 2012 (no further updates will be made) Establishing the Exchange  On November 28, 2012, Governor Jan Brewer (R) informed federal officials that Arizona would default to a federally-facilitated health insurance exchange.1 Prior to her decision to default, the Governor had established the Office of Health Insurance Exchange to “organize the health insurance marketplace for easier evaluation by individuals and small businesses to acquire affordable health insurance.”2 While legislation establishing a…

  • State Exchange Profiles: Florida

    Other Post

    Final update made on December 14, 2012 (no further updates will be made) Establishing the Exchange In December 2012, Governor Rick Scott (R) announced that Florida would not be pursuing efforts to implement a state-based health insurance exchange.1 Governor Scott has been a vocal opponent of federal health reform and the state has refused multiple funding opportunities available through the Affordable Care Act (ACA).2 Florida was also the lead plaintiff in a lawsuit brought by 26 states…

  • Market Share of Largest Insurance Carrier in the Individual Insurance Market, 2010

    Feature

    Market Share of Largest Insurance Carrier in the Individual Insurance Market, 2010 Download Source Kaiser Family Foundation analysis of 2010 insurer filings to the National Association of Insurance Commissioners and the California Department of Managed Health Care using the Mark Farrah Associates Health Coverage Portal TM. Market share was calculated as the percent of the state’s individual insurance market enrollment accounted for by each parent company (measured in member months)