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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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  • 2019 Premiums for ACA Silver Plans Will Be 16 Percent Higher Than They Would Have Been Absent the Repeal of the Individual Mandate, Expansion of Short-Term Plans and Loss of Federal Cost-Sharing Payments, Analysis Finds

    News Release

    Although 2019 premiums for plans in the Affordable Care Act marketplaces are flat or falling in many parts of the country, they would be substantially lower still if not for several Trump administration-backed changes to private insurance markets, finds a new KFF analysis. ACA silver-level plans sold in the marketplaces will cost an average of 16 percent more than they otherwise would have, thanks to the combined effects of the loss of ACA cost-sharing reduction…

  • Poll: Majorities Favor a Range of Options to Expand Public Coverage, Including Medicare-for-All

    News Release

    At a time when debate is beginning about a national Medicare-for-all plan and other approaches to expanding coverage through public programs, this month’s KFF Health Tracking poll examines Americans’ early opinion on a range of options under consideration. The poll finds majority support for four different approaches: 77 percent of the public, including most Republican (69%), favor allowing people between the ages of 50 to 64 to buy health insurance through Medicare; 75 percent, including…

  • Health Care and the Candidates in the 2018 Midterm Elections: Key Issues and Races

    Issue Brief

    Introduction With the 2018 midterm election season in full swing, health care has emerged as one of the top issues for voters. The issue is playing a prominent role in many House, Senate, and gubernatorial races, and health-related measures have made it onto the ballot in several states. Democratic candidates, in particular, have made health care a central part of their campaigns and a focus of their political ads, highlighting popular provisions in the Affordable…

  • “Partial” Medicaid Expansions Could Limit States’ Spending But Cover Fewer People at a Higher Federal Cost Compared to Traditional ACA Expansions

    News Release

    If states were able to receive enhanced Affordable Care Act matching funds for “partial” expansions of Medicaid, fewer people would get health coverage and the federal government would spend more, compared to a traditional expansion under the law, KFF explains in a new brief. The explainer describes how a partial expansion would differ from a traditional ACA Medicaid expansion and summarizes some of the expected effects. It also documents which states have sought federal approval…

  • How Affordable are 2019 ACA Premiums for Middle-Income People?

    Issue Brief

    This analysis finds that Affordable Care Act marketplace premiums are least affordable for older adults who earn too much to qualify for federal subsidies, especially those living in rural areas where premiums are highest. The analysis also discusses a variety of state and federal proposals that seek to lower premiums for middle-class people buying their own insurance who are ineligible for ACA subsidies.

  • Expanding Medicaid to Low-Income Childless Adults Under Health Reform: Key Lessons From State Experiences

    Issue Brief

    The health reform law will expand Medicaid to millions of low-income adults, including many childless adults who have historically been ineligible for the program, necessitating one of the largest enrollment efforts in the program's history. This report, based on interviews with officials in seven states and the District of Columbia and national experts, examines lessons learned from past state experience covering childless adults through waiver and state-funded programs and profiles the programs included in the…

  • Public Reporting of Quality Outcomes: What’s the Best Path Forward?

    Event Date:
    Event

    The Affordable Care Act aims to promote higher quality care in part by rewarding – and eventually requiring – the reporting of certain quality measures. Previous efforts suggest that public reporting can add significant value. Yet there are concerns about the best way to measure outcomes and quality, the possible unintended effects of public reporting, and whether purchasers and consumers actually use the information to make choices. Panelists at this April 27 briefing co-sponsored by…

  • Peering Into the Black Box of Insurance Rating

    Perspective

    Recently, the New York Times reported that private health insurers continue to seek large premium increases despite seeing lower than expected use of medical care and booking record profits. The story highlights a significant problem for health policy: the lack of good, public information about how health insurers manage health care use and what they pay for medical services. As a nation, we rely on competition among largely private health plans to ensure that health…

  • Remember the People Outside of the Exchanges

    Perspective

    There has been a substantial amount of focus on the recently released draft regulations governing state-based health insurance exchanges under the Affordable Care Act (ACA). And that's appropriate, since the exchanges have the important roles under reform of providing consumers with easier access to insurance and facilitating tax credits and cost-sharing subsidies that make coverage more affordable. But, as central as exchanges will likely be, it's important to remember that there are other key provisions that help…