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?

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  • How the Loss of Cost-Sharing Subsidy Payments is Affecting 2018 Premiums

    Issue Brief

    This analysis of 32 states and Washington, D.C., tracks data on 2018 Affordable Care Act (ACA) marketplace premium increases that insurers directly attributed to the end of cost-sharing reduction payments, which reimburse insurers for providing marketplace health plans with reduced out-of-pocket costs for lower-income people. Following months of uncertainty, the Trump administration announced on Oct. 12 that the payments would be discontinued immediately, although insurers must still offer the subsidized coverage.

  • Data Note: Public’s Views of a National Health Plan

    Feature

    The Kaiser Family Foundation's Health Tracking Poll from October 2017 asked the public of their views of a national health plan, and whether they favor or oppose the implementation of such a program. While about half of the public favors having a national health plan, there is a strong partisan divide with the majority of Republicans strongly opposing such a plan and nearly half of Democrats strongly favoring the plan. This poll also asked the…

  • How Medicaid Section 1115 Waivers Are Evolving: Early Insights About What to Watch

    Issue Brief

    While efforts to pass major federal legislation to repeal and replace the Affordable Care Act (ACA) and restructure and reduce federal Medicaid financing may be on hold temporarily, the focus of the Centers for Medicare and Medicaid Services (CMS) and states is expected to turn to achieving significant Medicaid program changes through Section 1115 demonstration waivers. This issue brief presents three questions to help analyze the evolution of federal waiver policy as new waiver proposals…

  • Keeping the Alexander-Murray Health Care Bill in Context

    From Drew Altman

    This Drew Altman Axios column describes the scale of the problems in the ACA marketplaces and the public’s confusion about whether they are impacted. He says that the news media, experts and policy makers can do more to put the marketplace problems and fixes in context as debate evolves.

  • Web Briefing for Journalists: Marketplace Open Enrollment in the Trump Era

    Event Date:
    Event

    With the Trump administration’s announcements last week, the landscape around Affordable Care Act marketplaces and the open enrollment period beginning Nov. 1 continues to shift. Though the 2010 health law remains intact for now, consumers will see fundamental differences this year when it comes to signing up for 2018 marketplace plans. Premiums are increasing significantly in some states, though not all consumers will feel the impact. The enrollment period is shorter. Healthcare.gov will experience regular…

  • As Senate Weighs Bipartisan Stabilization Bill with Cost-Sharing Reduction Funding, Current Marketplace Enrollees Face Challenges with Affordability 

    News Release

    Knowledge and Awareness of Key Facts Regarding Enrollment Is Low As the Nov. 1 start of the Affordable Care Act’s open enrollment period nears, new polling data from the Kaiser Family Foundation finds that most potential enrollees are unaware of when they can enroll and have not seen any related advertisements. Fielded prior to yesterday’s announcement of a bipartisan marketplace stabilization deal in the Senate that among other things would increase outreach funding, the survey…

  • Kaiser Health Tracking Poll – October 2017: Experiences of the Non-Group Marketplace Enrollees

    Feature

    The start of the open enrollment period for non-group insurance in 2018 is less than one month away, and the majority of individuals who are targets for enrollment – those who currently purchase their own insurance and those who are uninsured – are unaware of the key dates of the next open enrollment period. This report, focusing on enrollees in the non-group market, compares the experiences of individuals who purchase their own insurance through an…