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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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  • Health Insurance Market Reforms: Pre-Existing Condition Exclusions

    Fact Sheet

    Insurers pursue multiple strategies to reduce the cost of covering enrollees with pre-existing conditions, or medical conditions and health problems that existed before the individual enrolled in a health plan. One strategy, the pre-existing condition exclusion, allows insurers to refuse to cover any costs associated with care for a pre-existing condition permanently or over a period of time. Beginning January 1, 2014, insurers in the individual and group markets will be prohibited from imposing pre-existing…

  • Quick Take: An Update on the ACA & HIV: Medicaid Health Homes

    Fact Sheet

    We recently wrote about the different ways in which the Affordable Care Act (ACA) changes pathways to health insurance coverage for people with HIV, and chronicled these specifics, as well as several outstanding questions, in a policy brief.  As we noted, among the many provisions of the ACA designed to improve care is a new option available to state Medicaid programs to provide “health homes” for Medicaid enrollees with chronic conditions, with a temporary enhanced…

  • Health Care Reform Newsmaker Series: Sen. Max Baucus (D-Mont.)

    Event Date:
    Event

    Sen. Max Baucus (D-Mont.), chairman of the Senate Committee on Finance, appeared as the first guest in a new series of Health Care Reform newsmaker briefings sponsored by the Kaiser Family Foundation, Families USA and the National Federation of Independent Business. The reporters-only briefings, designed to inform the public about prospects and options for health reform, feature a short presentation by an influential leader followed by an extended question-and-answer session. Transcript (.pdf) Video

  • Kaiser Health Tracking Poll: Election 2008 — August 2008

    Poll Finding

    The latest Kaiser Health Tracking Poll: Election 2008 poll finds that one in four (24%) Americans continues to struggle with paying for health care. Health care ranks as a "serious problem" above paying for food (18%), problems with debt (16%), and paying the rent or mortgage (15%) and below paying for gas (37%) or getting a good paying job or raise in pay (26%). Among the 24 percent that find paying for health care or…

  • Health Care Reform Newsmaker Series: Sen. Chris Dodd

    Event Date:
    Event

    This webcast captures an April 28, 2009 briefing with Sen. Chris Dodd (D-Conn.), senior member of the U.S. Senate Committee on Health, Education, Labor and Pensions. The briefing was part of the Health Care Reform Newsmaker series sponsored by the Kaiser Family Foundation, Families USA and the National Federation of Independent Business. The reporters-only briefings, designed to inform the public about prospects and options for health reform, feature a short presentation by an influential leader…

  • How Much Will Medicaid Physician Fees for Primary Care Rise in 2013? Evidence from a 2012 Survey of Medicaid Physician Fees

    Issue Brief

    This brief presents 50-state data from the 2012 KCMU/Urban Institute Medicaid Physician Fee Survey. It estimates that average Medicaid fees to qualified physicians for Affordable Care Act primary care services will rise by 73 percent when the primary care fee increase takes effect on January 1, 2013, although there will be wide state variation. The paper presents data showing how states compare in their 2012 Medicaid fee levels, how Medicaid fees compared to Medicare fees,…

  • Coverage for Abortion Services and the ACA

    Issue Brief

    This issue brief, Coverage of Abortion Services and the Affordable Care Act (ACA), summarizes the major coverage provisions of the ACA that are relevant for women of reproductive age, reviews current federal and state policies on Medicaid and insurance coverage of abortion services as they relate to the ACA, and presents national and state estimates on the availability of abortion coverage for women who are newly eligible for Medicaid or private coverage through the Marketplaces…

  • Health Care Access and Coverage for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community in the United States: Opportunities and Challenges in a New Era

    Perspective

    This Policy Insight looks at the challenges and questions surrounding recent policy changes that are expected to increase health insurance coverage and access to care for lesbian, gay, bisexual and transgender (LGBT) individuals and their families, including the impact of the Affordable Care Act (ACA) and the Supreme Court's DOMA decision.

  • JAMA Forum: Why the Ruckus Over the Cadillac Plan Tax?

    Perspective

    Larry Levitt’s October 2015 post explains the terms of the much-debated Cadillac plan tax, how it is designed to reduce health costs, and how it could end up shifting more costs to workers.