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Affordable Care Act

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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  • How Obamacare’s Progress Makes Expanding Coverage Harder

    From Drew Altman

    This was published as a Wall Street Journal Think Tank column on July 21, 2014. The Affordable Care Act’s success meeting its initial enrollment goals and the repair of HealthCare.gov seem to have calmed the political waters for Obamacare. But the job of enrolling the uninsured gets harder, not easier, because the remaining uninsured will generally be tougher to reach. Recent surveys show, roughly in line with expectations, that 8 million to 9.5 million fewer adults are uninsured compared with last year before…

  • A Profile of Community Health Center Patients: Implications for Policy

    Issue Brief

    Community health centers are a key source of primary care in underserved areas. Their role will grow as coverage expands under the ACA. To sharpen understanding of the health center patient population, this brief compares them to the low-income population overall, using the Health Center Patient Survey and National Health Interview Survey. The pre-ACA profile of health center patients that emerges sets the stage for measuring change and highlights important implications of states’ Medicaid expansion…

  • A Guide to the Supreme Court’s Review of the Contraceptive Coverage Requirement

    Issue Brief

    This issue brief dissects the issues raised by the legal challenges to the Affordable Care Act’s requirement that private insurance plans include contraception as part of their coverage of preventive services for women. Over 40 for-profit corporations and over 40 nonprofit corporations have filed lawsuits claiming that the requirement to provide their employees with contraceptives violates their religious rights. On November 26, 2013, the Supreme Court agreed to hear two cases filed by for-profit corporations,…

  • How Will the Uninsured in Arkansas Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Arkansas, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Arkansas are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Colorado Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Colorado, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Colorado are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Idaho Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Idaho, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Idaho are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Kansas Fare Under the Affordable Care Act?

    Fact Sheet

    The 2010 Affordable Care Act (ACA) has the potential to extend coverage to many of the 47 million nonelderly uninsured people nationwide, including the 369,000 uninsured Kansans. The ACA establishes coverage provisions across the income spectrum, with the expansion of Medicaid eligibility for adults serving as the vehicle for covering low-income individuals and premium tax credits to help people purchase insurance directly through new Health Insurance Marketplaces serving as the vehicle for covering people with…

  • How Will the Uninsured in Maine Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Maine, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Maine are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Michigan Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Michigan, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Michigan are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Mississippi Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Mississippi, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Mississippi are eligible for Medicaid or financial assistance in…