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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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  • Restructuring Medicaid in the American Health Care Act: Five Key Considerations

    Issue Brief

    On March 9, the House Ways and Means Committee and Energy and Commerce Committee passed the American Health Care Act, the Republican leadership’s plan to repeal and replace the ACA. The Congressional Budget Office estimates that the House bill would reduce federal Medicaid spending by $880 billion over ten years by capping federal Medicaid spending and ending enhanced federal funding for Medicaid expansion adults. By 2026, federal Medicaid spending would be 25% lower than expected…

  • Web Briefing for Journalists – Potential Changes to Health Care Access and Coverage: What’s at Stake for Women?

    Event Date:
    Event

    House Republicans’ American Health Care Act and other actions under discussion by President Donald Trump’s administration and the new Congress could profoundly affect access to health care for many women. Repeal of the Affordable Care Act, changes to its birth control coverage provision, and new state and federal abortion restrictions, along with potential funding cuts and restrictions for family planning providers, including Planned Parenthood, would significantly impact the availability and cost of women’s health care,…

  • Poll: Early Perceptions of House Bill Show Public Thinks It Would Cover Fewer People and Raise Health Costs

    News Release

    Republicans More Likely to Expect Positive Changes Than Democrats or Independents Large Majority Favors Continued Medicaid Funding to Planned Parenthood Fielded March 6-12 as Americans were first learning about the American Health Care Act and before the Congressional Budget Office estimated its effects, the latest Kaiser Tracking Poll shows that large shares of the public expect the House Republican health care plan would result in fewer people having health insurance and higher costs for people…

  • Kaiser Health Tracking Poll: ACA, Replacement Plans, Women’s Health

    Feature

    The latest Kaiser Health Tracking Poll examines the public’s early attitudes towards the House Republican plan to repeal and replace the Affordable Care Act and finds that more expect the new plan will make things worse rather than better when it comes to the number of people with coverage and costs for those buying insurance on their own. The survey also measures public support for continuing current federal Medicaid funding to Planned Parenthood, gauges the…

  • How Affordable Care Act Repeal and Replace Plans Might Shift Health Insurance Tax Credits

    Issue Brief

    The Affordable Care Act, also known as Obamacare, and leading replacement proposals rely on refundable tax credits to help individual market enrollees pay for premiums, although the credit amounts are set quite differently. This analysis compares estimates of an average 2020 tax credit amount under the ACA with averages under the House Republicans' American Health Care Act, introduced March 6, 2017.

  • The American Health Care Act: New House GOP Bill Summary and Interactive Maps of Its Effects on Tax Credits

    News Release

    The Kaiser Family Foundation today issued a summary of the Republican House leadership’s March 6 proposed Affordable Care Act (ACA) replacement bill, the American Health Care Act, that can be compared in 17 key policy areas to the ACA and several other proposed replacement plans. In addition, the Foundation updated its interactive maps that compare county-level estimates of premium tax credits consumers would receive under the Affordable Care Act (ACA) in 2020 with what they’d receive…

  • Views of Governors and Insurance Commissioners on ACA Repeal and Changes to Medicaid: Responses to a Congressional Request for State Input on Health Reform

    Issue Brief

    This brief summarizes responses from governors and insurance commissioners in 35 states, including DC, to a request from members in the House of Representatives for state input on health care reforms. These responses provide insight into state leaders’ views on repeal and replacement of the ACA and the changes Congress is considering making to the financing and structure of Medicaid. It finds that respondents have mixed views on the ACA and potential repeal and replacement…

  • Polling Data Note: Beyond the ACA, the Affordability of Insurance Has Been Deteriorating Since 2015

    News Release

    The debate about the future of the Affordable Care Act and its individual insurance marketplaces may be taking the focus off the affordability challenges facing the broader population, most of whom get their health coverage through employers, Medicare or Medicaid. New survey findings from the Kaiser Family Foundation show that health care has become somewhat less affordable even among those with health insurance. Since 2015, larger shares of people with health insurance say they have…

  • KFF Analysis: Average Health Insurance Tax Credit for Consumers Would Be at Least a Third Lower Under Currently Discussed Replacement Plans than the ACA

    News Release

    A new analysis from the Kaiser Family Foundation estimates that the average health insurance premium tax credit received by consumers in 2020 would be at least 36 percent lower under replacement proposals being discussed by Republicans in Congress than under the Affordable Care Act. The average tax credit also would increase more slowly under replacement proposals, the analysis finds: In the House Discussion Draft alternative to the ACA, which has been recently discussed in media…

  • Kaiser Health Tracking Poll: Future Directions for the ACA and Medicaid

    Feature

    This month’s Kaiser Health Tracking Poll explores the public’s views on the changing landscape of the U.S. health care system including proposals to repeal and replace the Affordable Care Act (ACA) and to change Medicaid financing to a system of block grants or per capita allotments. The survey also examines which sources, including news media and other sources, the public trusts for information on the proposed changes to the country’s health care system.