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The ACA MarketplaceS

How Has Marketplace Enrollment Changed Across States in 2026?

Following several years of rapid enrollment growth in the ACA Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the enhanced tax credits, generally saw lower drops in enrollment.

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 Flexibility to Address Health Insurance Challenges under the American Health Care Act, H.R. 1628

    Issue Brief

    The American Health Care Act (AHCA), a bill passed by the House in May 2017 to repeal and replace the Affordable Care Act (ACA), would present states with new authority in individual insurance markets, along with a number of difficult problems and choices and limited resources with which to address them. States would be able to obtain waivers and would be eligible for $123 billion in grant funds, including money from a new Patient and…

  • What’s Really At Stake In the Medicaid Spending Debate

    From Drew Altman

    In this Axios column, Drew Altman highlights that the federal debate about the American Health Care Act’s Medicaid spending reductions will ultimately be a debate about every state’s general budget spending priorities, as states discuss whether to offset reductions in federal revenues with some combination of cuts to their Medicaid programs, increased taxes, and cuts to spending in other areas.

  • Poll: Public Views the ACA More Favorably Than Congress’ Plan to Replace It, Though Republicans Favor the Replacement

    News Release

    Public Grows More Pessimistic About How Repeal Will Affect Them Personally Most (55%) of the public holds an unfavorable view of the Congressional plan that would repeal and replace the Affordable Care Act, and the same share (55%) want the Senate either to make major changes to the House-passed bill or not pass it all, finds the latest Kaiser Health Tracking Poll. Three in 10 (31%) of the public hold favorable views of the American…

  • Kaiser Health Tracking Poll – May 2017: The AHCA’s Proposed Changes to Health Care

    Report

    With House Republicans passing the American Health Care Act (AHCA), their plan to repeal and replace the Affordable Care Act (ACA), and the Senate currently debating the plan and discussing their own approach, the latest tracking poll finds more view the ACA favorably than view the AHCA favorably. The poll examines attitudes towards specific provisions included in the replacement plan and how the public thinks the replacement plan will affect their own health care.

  • The Other Implication of the CBO Report: Election-Year Pain

    From Drew Altman

    In this Axios column, Drew Altman lays out how the “political pain” from the American Health Care Act would play out over the next two election cycles if passed in its current form, based on the Congressional Budget Office’s analysis of the House-passed bill.

  • Comparison of Medicare Provisions in Recent Bills and Proposals to Repeal and Replace the Affordable Care Act

    Issue Brief

    Repealing and replacing the Affordable Care Act is a top priority of the Trump Administration and the Republican leadership, which could have implications for the Medicare program. This brief provides a side-by-side comparison of the Medicare-related provisions in six bills and proposals that would repeal the ACA, excluding proposals that would not directly affect Medicare.

  • AHCA Quiz Icon

    American Health Care Act (AHCA) Quiz

    Feature

    On May 4, 2017, the US House of Representatives approved the American Health Care Act (AHCA), legislation to repeal and replace the Affordable Care Act (ACA).  On May 24, the Congressional Budget Office scored the latest version of this bill. Do you think you’re an expert on the AHCA?  Take this quiz to test your knowledge.

  • Implications of Reduced Federal Medicaid Funds: How Could States Fill the Funding Gap?

    Issue Brief

    In this analysis, we present three scenarios of reductions in federal Medicaid spending and examine fiscal implications if states fill these financing gaps to maintain their programs and if all reductions are assumed to be in full effect in FFY 2015 (the most recent year for which Medicaid spending data is available). To fill these gaps in financing and maintain current Medicaid programs, we assume states will increase state spending for Medicaid by increasing state…

  • Analysis: 6.3 Million People with Pre-Existing Conditions Would Be at Risk for Higher Premiums under the House’s Health Bill

    News Release

    A new Kaiser Family Foundation analysis estimates that 6.3 million people -- 23 percent of 27.4 million non-elderly adults with a gap of several months in insurance coverage in 2015 – could potentially face higher premiums under the House’s American Health Care Act (AHCA), due to pre-existing health conditions. The bill, which passed the House earlier this month, allows states to waive community rating in the individual insurance market. Insurers in states with such waivers…

  • Gaps in Coverage Among People With Pre-Existing Conditions

    Issue Brief

    The American Health Care Act (AHCA), which has passed the House of Representatives, contains a controversial provision that would allow states to waive community rating in the individual insurance market. In this brief we estimate the number of people with pre-existing conditions who might be affected by such a policy.