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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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  • State Exchange Profiles: Kansas

    Other Post

    Final update made on March 21, 2013 (no further updates will be made) Establishing the Exchange After placing health insurance exchange planning on hold until after the November elections, Governor Sam Brownback (R) announced on November 9, 2012, Kansas would default to a federally-facilitated exchange.1,2 With the initial endorsement of the Governor in 2011, Kansas Insurance Commissioner Sandy Praeger, had established eight exchange planning work groups comprised of hundreds of volunteers across civic groups, government…

  • State Marketplace Profiles: Hawaii

    Other Post

    Final update made on November 6, 2013 (no further updates will be made)  Establishing the Marketplace On July 11, 2011, Governor Neil Abercrombie (D) signed SB 1348 into law establishing the Hawaii Health Connector, a State-based health insurance Marketplace.1  The law builds on Hawaii’s Prepaid Health Care Act of 1975 (PHCA) which required nearly all employers to provide health insurance to employees working 20 or more hours a week for four consecutive weeks.2  Structure: The legislation established the…

  • State Marketplace Profiles: Arkansas

    Other Post

    Final update made on October 29, 2013 (no further updates will be made) Establishing the Marketplace On December 12, 2012, Governor Mike Beebe (D) informed federal officials that Arkansas would pursue a state-federal partnership health insurance Marketplace (also referred to as exchange).1  A state opting for a partnership Marketplace can choose to operate plan management functions, consumer assistance functions, or both. A state can also elect to perform Medicaid and Children’s Health Insurance Program (CHIP)…

  • State Exchange Profiles: Arizona

    Other Post

    Final update made on December 4, 2012 (no further updates will be made) Establishing the Exchange  On November 28, 2012, Governor Jan Brewer (R) informed federal officials that Arizona would default to a federally-facilitated health insurance exchange.1 Prior to her decision to default, the Governor had established the Office of Health Insurance Exchange to “organize the health insurance marketplace for easier evaluation by individuals and small businesses to acquire affordable health insurance.”2 While legislation establishing a…

  • State Exchange Profiles: Florida

    Other Post

    Final update made on December 14, 2012 (no further updates will be made) Establishing the Exchange In December 2012, Governor Rick Scott (R) announced that Florida would not be pursuing efforts to implement a state-based health insurance exchange.1 Governor Scott has been a vocal opponent of federal health reform and the state has refused multiple funding opportunities available through the Affordable Care Act (ACA).2 Florida was also the lead plaintiff in a lawsuit brought by 26 states…

  • How Much Financial Assistance Are People Receiving Under the Affordable Care Act?

    Issue Brief

    This analysis examines the amount of financial assistance that people have qualified for through premium tax credits in the new health insurance marketplaces (also known as exchanges) under the Affordable Care Act through the end of February 2014. The brief also examines the implications that the enrollment variation carries for the potential tax benefits the Affordable Care Act offers to state residents.

  • The Individual Mandate: How Sweeping?

    Perspective

    The so-called "individual mandate"  – the provision under the Affordable Care Act (ACA) that requires most individuals to carry a minimum level of insurance coverage and is now being considered by the Supreme Court – has emerged as the least popular element of the reform law and the prime target for its opponents. Yet in practice, the mandate may not be quite as far-reaching as the controversy over it suggests. The vast majority of Americans already…

  • The ACA and Fluoridation: The Power of Political Symbols

    Perspective

    In the 1950s, water fluoridation became a public health controversy that morphed into a symbolic issue of larger proportions. For its opponents, fluoridation came to symbolize big government and even for some, a communist threat. The controversy became so odd that it was parodied in Stanley Kubrick’s 1964 film “Dr. Strangelove,” in which General Jack Ripper starts a nuclear war to stop a communist plot to “sap and impurify all of our precious bodily fluids”…

  • Some Malleability In Views On Medicaid Expansion

    Feature

    Some Malleability In Views On Medicaid Expansion Download Source Kaiser Family Foundation/Robert Wood Johnson Foundation/Harvard School of Public Health, The Public’s Health Care Agenda for the 113th Congress (conducted January 3-9, 2013)