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The ACA Marketplace

2025 KFF Marketplace Enrollees Survey

About one in three ACA enrollees said they would be “very likely” to look for a lower-premium Marketplace plan If their premium payments doubled, according to a KFF survey conducted in 2025.

New AND NOTEWORTHY

Tracking the Public’s Views on the ACA

While overall opinion of the Affordable Care Act has been more favorable than unfavorable since 2017, there remain deep partisan divides. See how public opinion on the ACA has changed from the inception of the law to the present. This interactive tool highlights key moments when views shifted and trends based on party identification, income, age, gender, and race/ethnicity.

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  • “Partial” Medicaid Expansions Could Limit States’ Spending But Cover Fewer People at a Higher Federal Cost Compared to Traditional ACA Expansions

    News Release

    If states were able to receive enhanced Affordable Care Act matching funds for “partial” expansions of Medicaid, fewer people would get health coverage and the federal government would spend more, compared to a traditional expansion under the law, KFF explains in a new brief. The explainer describes how a partial expansion would differ from a traditional ACA Medicaid expansion and summarizes some of the expected effects. It also documents which states have sought federal approval…

  • Medical Debt: The Canary in the Coal Mine for Health Care Affordability

    Perspective

    With Vice President Harris promising to address medical debt as part of her economic plan, KFF Executive Vice President for Health Policy Larry Levitt explores why it is a symptom of the broader problem of affordable health care and reviews recent efforts to address it in this JAMA Health Forum post.

  • The Biden Administration’s Final Rule on Section 1557 Non-Discrimination Regulations Under the ACA

    Issue Brief

    This brief overviews the Biden Administration’s 2024 final rule implementing Section 1557 of the ACA, which is home to the law’s major nondiscrimination provisions. It provides a brief background on 1557 rulemaking and identifies key differences between this rule and the 2020 rule from the Trump Administration. It highlights two areas of growing interest impacted by the rule – nondiscrimination protections related to pregnancy and nondiscrimination protections for transgender people. Table 2 summarizes the major…

  • KFF Examines New Rule Giving LGBTQ+ People More Protections Against Discrimination in Health Care

    News Release

    A long-awaited new rule recently finalized by the Biden Administration gives LGBTQ+ people more protections against discrimination when seeking health care and coverage from a range of programs and organizations, including Medicaid, Medicare, Health Insurance Marketplaces, many health insurance plans, and most hospitals and providers. The rule has been subject to a wave of litigation across the Obama, Trump, and Biden Administrations and the Biden Administration's new rule reinstates protections eliminated by the Trump Administration.…

  • States with the Fastest Recent Growth in ACA Marketplace Coverage Started with High Uninsured Rates

    News Release

    The states with the fastest recent growth in ACA Marketplace signups also had among the highest uninsured rates previously, as enhanced subsidies helped to make coverage more affordable for many consumers, particularly in southern states that did not expand their Medicaid programs to cover low-income adults, a new KFF analysis finds. The enhanced premium subsidies were first provided in the American Rescue Plan Act in 2021 and then extended through 2025 in the Inflation Reduction Act.…

  • Explaining the Muddle on ACA Tax Credits

    From Drew Altman

    In his latest column, KFF’s President and CEO Dr. Drew Altman looks at why the issue of extending the enhanced ACA tax credits has languished in Congress without clear direction, despite its importance to the 24 million people who get their coverage in the ACA Marketplaces today and the potentially significant role the issue could play in the midterms if the credits are not extended.

  • Eliminating the Medicaid Expansion Federal Match Rate: State-by-State Estimates

    Issue Brief

    This analysis examines the potential impacts on states and Medicaid enrollees of eliminating the 90% federal match rate for the Affordable Care Act (ACA) expansion. Eliminating the federal match rate for adults in the Medicaid expansion could reduce Medicaid spending by nearly one-fifth ($1.9 trillion) over a 10-year period and up to nearly a quarter of all Medicaid enrollees (20 million people) could lose coverage.

  • Challenges with Effective Price Transparency Analyses

    Issue Brief

    Promoting price transparency in health care is a policy approach with bi-partisan support in Congress and the public at large. This analysis examines the vast troves of price transparency data that payers are required and finds unlikely prices, inconsistencies, and other oddities that pose major challenges for efforts to use it to promote competition and drive down prices.

  • Individual Market Insurers Requesting Largest Premium Increases in More Than 5 Years

    Issue Brief

    This analysis of preliminary rate filings submitted by 105 ACA Marketplace insurers in 19 states and DC shows that ACA Marketplace insurers are requesting a median premium increase of 15% for 2026, which would represent the largest hike in premiums since 2018, the last time policy uncertainty contributed to sharp premium growth. The scheduled expiration of enhanced tax credits and impact of tariffs on some drugs, medical equipment, and supplies are among the factors pushing…

  • ACA Marketplace Enrollment Has More Than Doubled Since 2020, with the Fastest Growth Occurring in States Won by President Trump in 2024

    News Release

    Enrollment in Affordable Care Act (ACA) Marketplace health plans reached a record 24.3 million people, more than double the total in 2020, with most of the growth occurring in states won by President Trump in the 2024 election, a new KFF analysis finds.  Almost all states have seen increases in enrollment since 2020, including six states where enrollment has more than tripled: Texas (up 255%), Mississippi (up 242%), West Virginia (up 234%), Louisiana (up 234%),…