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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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  • Interactive Maps: Estimates of Enrollment in ACA Marketplaces and Medicaid Expansion

    Interactive

    As the 115th U.S. Congress deliberates the future of the Affordable Care Act, also known as Obamacare, an interactive map from the Kaiser Family Foundation provides estimates of the number of people in each congressional district who enrolled in a 2017 ACA marketplace health plan and the political party of each district’s representative as of October 2017. The analysis also includes maps charting the total number of people enrolled under the ACA Medicaid expansion in…

  • High-Risk Pools as Fallback for High-Cost Patients Require New Rules

    From Drew Altman

    In this Wall Street Journal Think Tank column, Drew Altman examines how Republicans would “split the risk pools” between the healthier and the sick in their Affordable Care Act replacement plans, using state high risk pools as a fallback for higher cost patients, and examines the steps that would be necessary to make them effective based on prior experience in the states.

  • JAMA Forum: What Might an ACA Replacement Plan Look Like?

    Perspective

    Larry Levitt's January 2017 post explains the logistics of a "repeal and delay" approach to the Affordable Care Act, and outlines key elements of a proposed replacement plan from Rep. Tom Price, who is President Trump's nominee for Secretary of Health and Human Services. The post is now available at The JAMA Forum.

  • Compare Proposals to Replace The Affordable Care Act

    Interactive

    President Donald Trump and Republicans in Congress have committed to repealing and replacing the Affordable Care Act (ACA). How do their replacement proposals compare to the ACA? How do they compare to each other? Includes the Graham-Cassidy-Heller-Johnson amendment (introduced 9/13/2017) as well as other proposals from key members of Congress.

  • Compare Key Elements of ACA Repeal and Replace Proposals with New Interactive Tool

    News Release

    President Trump and Republicans in Congress have committed to repealing and replacing the Affordable Care Act. A new interactive tool from the Kaiser Family Foundation enables users to create side-by-side comparisons of major ACA alternative plans, now including 2017 proposals from Sen. Rand Paul and from Sen. Bill Cassidy. With the tool, users can compare the plans’ approaches to more than a dozen key areas of health policy, including individual insurance market rules, requirements and…

  • A Comprehensive Review of Research Finds That the ACA Medicaid Expansion Has Reduced the Uninsured Rate and Uncompensated Care Costs in Expansion States, While Increasing Affordability and Access to Care and Producing State Budget Savings   

    News Release

      Multiple studies over the last five years find that the Affordable Care Act’s Medicaid expansion has increased health coverage, affordability, and access to care while producing budget savings for states and reductions in uncompensated care costs for hospitals and clinics, according to a KFF review of more than 300 studies and policy reports. Thirty-six states and the District of Columbia have adopted the ACA Medicaid expansion. The literature review provides a useful reference on…

  • Explaining Texas v. U.S.: A Guide to the 5th Circuit Appeal in the Lawsuit Challenging the Affordable Care Act 

    News Release

    The outcome of the Texas v. U.S. legal challenge to the Affordable Care Act (ACA) could have far-reaching consequences for the nation’s health system, from rolling back the expansion of Medicaid to removing protections for people with pre-existing conditions and revoking the ability of adult children to stay on their parents’ insurance plans up to age 26. In December, U.S. District Judge Reed O’Connor invalidated the entire ACA after finding the individual mandate unconstitutional. Today,…

  • State Actions to Improve the Affordability of Health Insurance in the Individual Market

    Issue Brief

    A number of states have taken steps to provide consumers with more affordable coverage options in the individual market, including the marketplaces. Some states are implementing strategies that lower premiums by building on, and increasing the stability of the individual market, while other states are expanding the availability of lower cost coverage sold outside the marketplaces that does not comply with ACA standards—an approach that could increase marketplace premiums further. This brief examines these different…