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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 Coverage and Care for the Homeless Population: Key Lessons to Consider for the 2014 Medicaid Expansion

    Report

    Beginning in 2014, the Affordable Care Act ACA provides for a significant Medicaid expansion uninsured, low-income adults. Given their low incomes and high uninsured rate, individuals experiencing homelessness could significantly benefit from this expansion. However, it will be important to address the barriers they face to enrolling in coverage and accessing needed care. This report, based on eight focus group discussions with administrators and frontline workers serving the homeless population in four cities, identifies enrollment…

  • Medicare Now and in the Future

    Issue Brief

    Download PDF Issue Medicare is a valuable source of health insurance for nearly 45 million Americans – mainly seniors ages 65 and older, but also 7 million younger adults with permanent disabilities.  Before Medicare was signed into law in 1965, about half of all seniors lacked hospital insurance.  Today, virtually all people ages 65 and over are covered by Medicare.  Medicare is a popular program, but faces a number of issues and challenges in the…

  • Kaiser Health Tracking Poll — November 2009

    Poll Finding

    The November Kaiser Health Tracking Poll shows little movement in measures of public opinion about health reform from recent months. Among the new findings is a ranking of the public's top priorities from among a list of elements of the legislation. There were both similarities and differences in priorities across partisan groups: while assuring the availability of affordable plans ranked in the top three priorities for Democrats, Republicans and independents, deficit neutrality ranked in the…

  • Health Care in the 2008 Presidential Primaries

    Poll Finding

    This analysis find that the sharply contrasting health care platforms of the leading Democratic and Republican presidential candidates reflect dramatic differences in the perspectives of their primary voters. The article analyzes a newly released Kaiser/Harvard survey of likely primary voters in 35 states (and the District of Columbia) with January or February primaries or caucuses, as well as data from 10 other recent surveys by national media polling organizations. The article, "Health Care in the…

  • Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA)

    Fact Sheet

    This fact sheet provides an overview of provisions of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), which was signed into law in February 2009. The Act extends and expands the State Children's Health Insurance Program (now referred to as CHIP, not SCHIP) that was enacted with bipartisan support a decade ago as part of the Balanced Budget Act of 1997 (BBA). Fact Sheet (.pdf) Fact Sheet: State Adoption of Coverage and Enrollment…

  • Pulling it Together: What Conservatives Are Winning

    Perspective

    Conservatives are out of sorts these days about the direction in which health care is headed. They think the new health reform law expands the role of government too much and spends too much at a time when they believe deficit reduction should be a higher priority. The claims about death panels and a government takeover of the health system aside, these are principled positions for conservatives to take – they are supposed to be…

  • Coping with Fragmented Payment in the Real World

    Event Date:
    Event

    The Alliance for Health Reform and The Commonwealth Fund sponsored this briefing which focused on three communities that have reformed and harmonized health care payments across payers to improve care: a New York health center that serves a low income population; a Colorado community that pools money from public and private sources to provide care for all patients; and the State of Maryland, which has been using an all payer hospital rate setting system for…

  • Affordability and Health Reform: If We Mandate, Will They (and Can They) Pay?

    Event Date:
    Event

    The Alliance for Health Reform and The Commonwealth Fund co-sponsored this briefing to explore the health reform proposals being considered which may impose responsibilities on both individuals and employers to have and help pay for coverage and whether they will be able to pay the amounts above the subsidies. Questions addressed include:If Congress exempts people from the coverage requirement or significantly reduces the penalties for noncompliance, will enough healthy individuals purchase new coverage to adequately…

  • Coverage of Colonoscopies Under the Affordable Care Act’s Prevention Benefit

    Report

    The Affordable Care Act (ACA) requires private health insurers to cover recommended preventive services such as colonoscopies without any patient cost-sharing. This report finds that confusion over whether colon cancer screenings are preventive care or treatment means patients sometimes receive unexpected bills for the procedure. The report examines cost-sharing practices for colorectal screenings through interviews with experts and officials in the medical and insurance industries. This report was co-authored by The Kaiser Family Foundation, American…

  • Medicaid as a Platform for Broader Health Reform: Supporting High-Need and Low-Income Populations

    Issue Brief

    Medicaid is the health insurance safety net for nearly 60 million of the nation's poorest and sickest individuals. It provides access to a comprehensive scope of benefits with limited cost-sharing that is geared to meet the health needs and limited resources of the low-income, high-need populations it serves, populations for whom private coverage is often not available, not affordable or inadequate. This paper, based on years of research and analysis from the Kaiser Commission on…