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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.

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

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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  • New Analysis: Half of U.S. Households Eligible for a Tax Subsidy Under the Health Law Would Owe a Repayment, While 45 Percent Would Receive a Refund

    News Release

    Estimated Average Repayment is $794. Estimated Average Refund is $773. Half of U.S. households eligible for a 2014 tax subsidy under the Affordable Care Act would owe a repayment to the government, while 45 percent would receive a refund, according to estimates from a new analysis by the Kaiser Family Foundation. The analysis – which is a simulation based on historical patterns of income volatility among all households eligible for ACA premium subsidies -- estimates that the…

  • Issue Brief Looks At Experiences of People with HIV With Health Coverage Under the ACA

    News Release

    A new Kaiser Family Foundation issue brief examines the impact of the Affordable Care Act (ACA) on people with HIV in five states – California, Florida, Georgia, New York and Texas. Findings are drawn from focus groups in which participants discussed their experiences during the first year of the ACA’s major coverage expansions, with the goal of understanding the implications for individual HIV health outcomes and the nation's response to the epidemic. While many focus group…

  • Safety-Net Emergency Departments: A Look at Current Experiences and Challenges

    Issue Brief

    Safety-net hospital emergency departments (EDs) are an important part of our health care system, especially, but not only, for the uninsured and others with low income. With multiple major changes unfolding in our system today, including the development of new models of health care delivery, payment reforms, expanded insurance coverage, and increasing demand for primary care access, safety-net EDs are a sort of crucible in which these shifts and transitions can be seen playing out.…

  • Challenges for the Next Obamacare Open Enrollment

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman pinpoints the Affordable Care Act’s five biggest challenges heading into the second open enrollment period.

  • Open Enrollment: Insights from Medicare for Health Insurance Marketplaces

    Perspective

    This Policy Insight draws on the experiences of Medicare beneficiaries during Medicare’s annual enrollment period to consider whether consumers with health insurance coverage through the Affordable Care Act’s new marketplaces will shop for a better deal during their open enrollment season.

  • Nine in Ten Uninsured Unaware that the Affordable Care Act’s Second Open Enrollment Period Starts in November

    News Release

    Most of Those Without Health Coverage Report Knowing Little or Nothing About the Insurance Marketplaces or About the Financial Assistance Available to Low- and Moderate-Income Families Broader Public Opinion on the Law Still Tilts Unfavorably, Though Gap Has Narrowed Since July and Returned to Pre-Rollout Levels With the second annual open enrollment period under the Affordable Care Act set to begin Nov. 15, the latest Kaiser Family Foundation tracking poll finds major gaps in the…

  • Brief Provides Update on LGBT Coverage and Health as More States Recognize Same-Sex Marriage

    News Release

    An updated issue brief from the Kaiser Family Foundation gives a detailed profile of health concerns for lesbian, gay, bisexual and transgender individuals, offers the latest demographic data, and discusses the impact of recent changes in state and federal policies on health coverage, including the Affordable Care Act and same-sex marriage. As of this month, same-sex marriage is recognized in 32 states and the District of Columbia. The brief, Health and Access to Care and…

  • Obamacare: The Metrics In The News Are Mostly Wrong

    From Drew Altman

    In this Policy Insights, Kaiser Family Foundation President and CEO Drew Altman explains how the measures of success for year one of Obamacare used in media coverage and national discussion is the equivalent of judging the local weather from national averages.