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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.

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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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  • 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…

  • Kaiser Health Tracking Poll – Late April 2017: The Future of the ACA and Health Care & the Budget

    Report

    With the ongoing debate about the future of the Affordable Care Act (ACA), the latest tracking poll examines the public awareness of and attitudes about some recent developments related to the 2010 health care law, including uncertainty about cost-sharing reduction payments and insurers opting out of some health insurance marketplaces. The poll also takes a look at Americans’ budget and health care priorities.

  • Federal Government Could See Net Increase of $2.3 Billion in Costs in 2018 if ACA Cost-Sharing Reduction Payments Eliminated

    News Release

    Ceasing payments for the Affordable Care Act’s (ACA) cost-sharing reduction program could save $10 billion, but cost an additional $12.3 billion in premium tax credits – an estimated net increase of $2.3 billion, or 23 percent, in federal spending on marketplace subsidies – in 2018, if insurers continue to participate in ACA marketplaces, according to a new analysis from the Kaiser Family Foundation. The cost-sharing subsidies, established to reduce out-of-pocket costs for ACA marketplace enrollees…

  • The Effects of Ending the Affordable Care Act’s Cost-Sharing Reduction Payments

    Issue Brief

    This analysis estimates that total federal spending on Affordable Care Act marketplace subsidies would rise $2.3 billion, or 23 percent, in 2018 if payments for the cost-sharing reduction program were eliminated and insurers increased premiums to compensate. Established to reduce out-of-pocket costs for marketplace enrollees with lower incomes, the cost-sharing payments are being challenged in a lawsuit from the U.S. House.

  • Data Note: Medicaid Managed Care Growth and Implications of the Medicaid Expansion

    Issue Brief

    Most states today rely heavily on risk-based managed care organizations (MCOs) to serve Medicaid beneficiaries. This Data Note discusses the current role of managed care in Medicaid and examines differences in managed care growth between states that expanded Medicaid to low-income adults under the Affordable Care Act (ACA) and states that did not expand Medicaid.

  • Analysis: Insurer Financial Indicators Show Signs of Stabilizing After Transition to ACA Marketplaces

    News Release

    A new Kaiser Family Foundation analysis of key insurer financial indicators suggests that the individual insurance market showed signs of stabilizing in 2016, although profitability remained below the level of performance prior to the opening of the Affordable Care Act’s insurance marketplaces. The new analysis tracks insurer financial performance in the individual market through two key indicators: average medical loss ratios (the share of health premiums paid out as claims) and average gross margins per…

  • Why Trump’s Dealmaking Model Doesn’t Fit Health Care Policy

    From Drew Altman

    In this column as an Axios contributor, Drew Altman discusses President Trump's threat to withhold cost sharing subsidies and questions whether his approach to deal making can bridge health care's partisan and ideological divide. "Health policy is not like real estate," he says.

  • JAMA Forum: Is the Affordable Care Act Imploding?

    Perspective

    In this April 2017 post, Larry Levitt discusses the current status of the Affordable Care Act's health insurance marketplaces, and explains how the Trump administration's choices -- including whether to continue cost-sharing reduction payments to insurers -- could influence stability of the marketplaces going forward. The post is now available at The JAMA Forum.

  • A Warning From the Polls About Letting Obamacare “Explode”

    From Drew Altman

    In this column for Axios, Drew Altman sees a warning for the Trump administration and Republicans in the latest Kaiser Tracking Poll: the more they do to undermine the Affordable Care Act marketplaces the more the public is likely to hold them, and not the Democrats, accountable for the problems with the law.