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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

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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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  • What’s at Stake in a Potential Repeal of the ACA Medicaid Expansion?

    News Release

    President-elect Trump and Republican leaders in Congress have vowed to repeal the Affordable Care Act (ACA) and replace it with an alternative plan. There are now 32 states (including DC) that have adopted the ACA’s Medicaid expansion. While the details of a repeal-and-replace plan are not yet available to assess its impact, a new brief reveals what’s potentially at stake for Medicaid in the debate by examining the changes in health coverage and financing that…

  • Private Contracts Between Doctors and Their Medicare Patients:  Current Law, Proposed Changes and Implications for Beneficiaries

    News Release

    Under current law, physicians may choose to privately contract with their Medicare patients, though very few do.  Under such arrangements, doctors can charge their Medicare patients any amount they determine is appropriate for their services rather than be bound to Medicare’s set fees and balance billing limits, so long as the patients agree, and the contract complies with requirements in current law designed to protect consumers. Some Republicans in Congress have proposed to ease restrictions…

  • Do You Have the Facts About Medicare’s Financial Outlook for the Future?

    News Release

    Medicare is likely to be back on the federal policy agenda this year as Congress and President Trump pursue repealing and replacing the Affordable Care Act, and potentially consider options to reduce federal spending. When talking about Medicare, the nation’s federal health insurance program for 57 million people age 65 and over and younger people with disabilities, some policymakers often express concern that the program will soon be “bankrupt” and that rising spending is unsustainable.…

  • The Affordable Care Act’s Little-Noticed Success: Cutting the Uninsured Rate

    From Drew Altman

    This column was published as a Wall Street Journal Think Tank column on October 12, 2016. U.S. Uninsured Rate is At An All-Time Low, But The Public Doesn’t Know It Donald Trump derided the Affordable Care Act in the second presidential debate as a “total disaster.” One inarguable success of the 2010 health-care law has been to drive the rate of uninsured Americans to a historic low. That sizeable shift makes it significant that a plurality of the…

  • Obamacare? Zika? Which Health Stories Americans Actually Follow

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman analyzes the Kaiser Health Policy News Index to determine which health stories in the news have broken through to the public the most in the last year. One conclusion: it wasn't the Affordable Care Act.

  • Obamacare? Zika? Which Health Stories Americans Actually Follow

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman analyzes the Kaiser Health Policy News Index to determine which health stories in the news have broken through to the public the most in the last year. One conclusion: It wasn't the Affordable Care Act.

  • Amid Primary Debate about Universal Coverage, Most Democrats Now Want to Expand the Affordable Care Act, Leading to Somewhat Less Favorable Views of the Law Itself

    News Release

    Voters Rank Health Care Fourth As Issue for Presidential Candidates to Discuss With the Democratic presidential primary featuring a debate about how to get to universal health coverage in the United States, the latest Kaiser Health Tracking Poll finds most Democrats want Congress to expand the Affordable Care Act, contributing to a widening gap between unfavorable and favorable views of the health reform law. Overall the poll finds that this month 49 percent of the…

  • Is There a Health Care Vote? More for Democrats and Women than Other Groups

    News Release

    About One Third of Americans Perceive Wide-Scale Effort to Limit Women’s Reproductive Health Choices and Services; Most Who Do Say the Effort is a ‘Bad Thing’ Health care is one of many issues that will be important for voters in the presidential election, particularly for Democrats and women, finds the March Kaiser Health Tracking Poll. More than a third (36%) of voters consider health care “extremely important” to their vote in this year’s presidential election,…

  • The Affordable Care Act After Six Years

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman examines the role of the Affordable Care Act in the health system on its sixth anniversary, and how the hot debate about the law may have created an exaggerated impression of the good and the bad it can do. All previous Drew Altman columns are online.

  • The Affordable Care Act After Six Years

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman examines the role of the Affordable Care Act in the health system on its sixth anniversary, and how the hot debate about the law may have created an exaggerated impression of the good and the bad it can do.