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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.

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

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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  • Ten Ways That the House American Health Care Act Could Affect Women

    Issue Brief

    In this brief, the Kaiser Family Foundation outlines 10 ways women could be affected under the House of Representatives’ American Health Care Act. In particular, the brief analyzes how changes might affect Medicaid and its expansion population, financial assistance in the individual insurance market, coverage for essential health benefits and preventive services such as contraception, abortion, and maternity care, as well as insurance reforms such as gender rating.

  • Brief Examines Per Enrollee Medicaid Spending for Seniors and People with Disabilities, Which Varies Greatly By State

    News Release

    Medicaid coverage of acute and long-term care for more than 6 million low-income seniors and 10 million nonelderly people with disabilities accounts for nearly two-thirds of overall Medicaid spending, although such enrollees represent less than a quarter of people on Medicaid.  Much of Medicaid’s spending on seniors and people with disabilities also depends on state decisions about whom to cover and which services to pay for, which is a big reason why Medicaid spending per…

  • Primas y créditos impositivos bajo la Ley de Cuidado de Salud Asequible (ACA) vs el American Health Care Act (AHCA): Mapa Interactivo

    Interactive

    Estos mapas comparan los estimados de los créditos impositivos que los consumidores recibirían para pagar las primas en 2020, por condado, bajo la Ley de Cuidado de Salud Asequible (ACA) con lo que recibirían bajo el proyecto de líderes republicanos del Congreso llamado American Health Care Act (AHCA), que se dio a conocer el 6 de marzo.

  • State Variation in Medicaid Per Enrollee Spending for Seniors and People with Disabilities

    Issue Brief

    This issue brief explains the variation in Medicaid spending per enrollee for seniors, nonelderly adults with disabilities, and children with disabilities compared to other populations as well as the variation in per enrollee spending for these populations among states. It also provides a snapshot of state choices about optional eligibility pathways and services important to many seniors and people with disabilities.

  • Medicaid Coverage of Pregnancy and Perinatal Benefits: Results from a State Survey

    Report

    This report details findings from a state survey on perinatal benefits in place as of July 1, 2015 for women enrolled in fee-for-service Medicaid through different eligibility pathways, including traditional pre-ACA Medicaid pathways, expansion, and pregnancy-related eligibility for the following services: basic prenatal care, counseling and support services, delivery and postpartum care, and breastfeeding supports.

  • Medicaid Family Planning Programs: Case Studies of Six States After ACA Implementation

    Report

    In light of the coverage trends and other ACA-related changes, this paper describes the impact on women and their partners, as well as family planning providers, of the impact of family planning expansion programs under Medicaid. It is based largely on interviews with state officials, providers and consumer advocates in Alabama, California, Connecticut, Illinois, Missouri and Virginia – a cross-section of states in terms of geography, Medicaid expansion status, and implementation of a Medicaid family…

  • Poll: Majority Opposes Hard-Ball Negotiating Tactics to Replace the Affordable Care Act, But Republicans Support It

    News Release

    Somewhat More Want President Trump and Republicans to Continue Working on ACA Repeal and Replace than Want Them to Move onto Other Priorities With President Trump and Congress continuing to discuss repealing and replacing the Affordable Care Act, a majority of the public opposes using hard-ball tactics as a way to force Democrats in Congress to negotiate a replacement, the latest Kaiser Health Tracking Poll finds. President Trump recently suggested that his administration and Congress…