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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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  • Estoy teniendo problemas al abrir una cuenta del mercado online. Soy un adulto joven sin historial de crédito. ¿Puede ser ese el problema? ¿Qué debería hacer?

    FAQs

    Algunos consumidores con poco o ningún historial de crédito, como adultos jóvenes o nuevos inmigrantes, pueden tener dificultades para abrir cuentas en CuidadoDeSalud.gov. Esto se debe a que el mercado federal utiliza técnicas de prueba de identidad en tiempo real para proteger a los consumidores del acceso no autorizado a su información personal y evitar fraudes.Primero, debe verificar que haya ingresado toda la información solicitada para crear una cuenta, incluida la información etiquetada como opcional.…

  • New Survey Finds 1 in 5 Potential Marketplace and Medicaid Enrollees Used Consumer Assistance, But Many Others Report Trying and Failing to Obtain Help

    News Release

    A new KFF survey finds that nearly one in five potential marketplace and Medicaid enrollees – an estimated 7 million people - say that they got assistance applying for Affordable Care Act (ACA) marketplace plans or Medicaid in the past year, while one in eight – an estimated 5 million – tried and failed to obtain help. The survey suggests a shortage of consumer assistance prior to the COVID-19 pandemic, which has disrupted job-based health…

  • Recent Studies Show That Medicaid Expansion Has Improved the Financial Performance of Hospitals and Other Providers, In Line With Prior Research

    News Release

    A KFF synthesis of recent studies finds that Medicaid expansion has been beneficial to the finances of hospitals and providers, driving decreases in the share of uninsured patients, increases in Medicaid-covered patients and declines in uncompensated care. By financing coverage for low-income people who are likely to otherwise be uninsured, Medicaid expansion provides potential economic benefits to the health care providers who provide care to that population. Studies suggest that hospitals experienced higher reimbursements and…

  • 2022 Health Insurance Marketplace Calculator

    Interactive

    The Health Insurance Marketplace Calculator, updated with 2022 premium data, provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA).

  • Testimony: Tax-Exempt Hospitals and the Community Benefit Standard

    Issue Brief

    Zachary Levinson, Project Director of KFF’s Program on Medicare Policy, testified before the U.S. House of Representatives’ Committee on Ways and Means on April 26, 2023 as part of a hearing on Tax-Exempt Hospitals and the Community Benefit Standard.

  • Restructuring Medicaid in the American Health Care Act: Five Key Considerations

    Issue Brief

    On March 9, the House Ways and Means Committee and Energy and Commerce Committee passed the American Health Care Act, the Republican leadership’s plan to repeal and replace the ACA. The Congressional Budget Office estimates that the House bill would reduce federal Medicaid spending by $880 billion over ten years by capping federal Medicaid spending and ending enhanced federal funding for Medicaid expansion adults. By 2026, federal Medicaid spending would be 25% lower than expected…

  • Data Note: What if Per Enrollee Medicaid Spending Growth Had Been Limited to CPI-M from 2001-2011?

    Issue Brief

    Congress is currently debating the American Health Care Act (AHCA), which would repeal and replace the Affordable Care Act (ACA) and also make substantial changes to the structure and financing of Medicaid. Among other provisions, the AHCA would use a per capita cap policy to cap federal funds to states for Medicaid. This data note examines what the implications of tying per enrollee growth to CPI-M would have been for the 2001-2011 period for federal…

  • Early Implementation Experience of Medicaid Expansion Waivers in Michigan and Indiana Can Help Inform Future Medicaid Waivers

    News Release

    Michigan and Indiana, led by Republican governors, each obtained a waiver from the Obama Administration to expand Medicaid in ways that differ from the terms of the Affordable Care Act. Notably, both states’ expansions include provisions related to charging enrollees premiums, requiring them to contribute to health accounts and providing incentives to participate in healthy behavior programs, though the details and implementation vary considerably between the two states. A new analysis from the Kaiser Family…

  • Don’t Expect Medicaid Work Requirements to Make a Big Difference

    From Drew Altman

    Under the Trump Administration, some Republican governors may look to move their Medicaid programs in a more conservative direction. In his latest column for Axios, Drew Altman discusses the arguments about Medicaid “work requirements” and why few people are likely to be affected by them in practice.

  • Campaign 2016: Voters Give Clinton Wide Edge Over Trump on Trust to Handle Health Care Issues; ACA Ranks Lower Among Health Issues Voters Want Discussed

    News Release

    Electronic Medical Records: Eight in 10 Americans Say It Is Important for Providers to Computerize Records, But Half Worry About Unauthorized Access to Online Information With the 2016 elections just 10 weeks away, voters give Democratic presidential nominee Hillary Clinton a substantial advantage over Republican nominee Donald Trump on a wide array of health care issues, the latest Kaiser Health Tracking Poll finds. Two thirds of voters (66%), including large shares of Democrats, Republicans, and…