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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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  • Issue Brief Looks At Experiences of People with HIV With Health Coverage Under the ACA

    News Release

    A new Kaiser Family Foundation issue brief examines the impact of the Affordable Care Act (ACA) on people with HIV in five states – California, Florida, Georgia, New York and Texas. Findings are drawn from focus groups in which participants discussed their experiences during the first year of the ACA’s major coverage expansions, with the goal of understanding the implications for individual HIV health outcomes and the nation's response to the epidemic. While many focus group…

  • Safety-Net Emergency Departments: A Look at Current Experiences and Challenges

    Issue Brief

    Safety-net hospital emergency departments (EDs) are an important part of our health care system, especially, but not only, for the uninsured and others with low income. With multiple major changes unfolding in our system today, including the development of new models of health care delivery, payment reforms, expanded insurance coverage, and increasing demand for primary care access, safety-net EDs are a sort of crucible in which these shifts and transitions can be seen playing out.…

  • Insurer Competition, Monthly Premiums Could Be Affected in Some Markets if UnitedHealth Group Exits ACA Marketplaces

    News Release

    A withdrawal by UnitedHealth Group from the Affordable Care Act (ACA) marketplaces in 2017 could have a significant impact on insurer competition and premiums in some markets, though it would have a minimal effect on the average benchmark premium nationwide, according to a new analysis from the Kaiser Family Foundation. Late last year, UnitedHealth announced that it experienced significant financial losses in ACA compliant plans and that it would decide about future participation in ACA…

  • Most Americans Say Federal and State Governments Are Not Doing Enough to Combat Prescription Painkiller and Heroin Abuse; Large Majorities Believe Wide Range of Strategies Would be Effective

    News Release

     As the White House and Congress continue to debate new funding and other actions to address the nation’s opioid epidemic, the latest Kaiser Health Tracking Poll finds that most Americans believe the federal government is not doing enough to combat the recent increases in the number of people who are addicted to prescription painkillers (66%) or heroin (62%). State governments fare no better in the public’s view, with similarly large shares saying they aren’t doing…

  • Clinton-Sanders Contest Fuels Democratic Support for Expanding Obamacare

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman discusses how the debate between Hillary Clinton and Bernie Sanders about how to get to universal coverage has generated more support among Democrats for expanding the Affordable Care Act (and less support for the law as is).

  • Medicaid Expansion Waivers: What Will We Learn?

    Issue Brief

    Section 1115 waivers authorize research and demonstration projects that, in the view of the Health and Human Services (HHS) Secretary, further the purposes of the Medicaid program. The ACA implemented new requirements for these waivers, including that states must have a publicly available, approved evaluation strategy. This brief examines some of the major research questions and hypotheses relevant to the federal and state evaluations of Medicaid expansion Section 1115 waivers and explores key challenges that…

  • Assessing ACA Marketplace Enrollment

    Issue Brief

    This analysis examines factors that may have kept 2016 enrollment in Affordable Care Act (ACA) marketplace plans from reaching early projections, and it estimates that sign-ups will continue to grow modestly in coming years.

  • A New Way of Measuring Health Costs Sheds Light on Recent Health Spending Trends

    Issue Brief

    National health spending started to grow more rapidly recently after several years of unusually slow growth. This analysis from the Kaiser Family Foundation and the federal Bureau of Economic Analysis helps to dissect why that may be happening. Using recently-released disease-based health spending data compiled by the federal government, the analysis finds that the drivers of health spending growth shifted in the years following the Great Recession. The number of people treated for various diseases picked up,…