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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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  • Key Issues in Children’s Health Coverage

    Issue Brief

    This brief reviews children’s coverage today and examines what is at stake for children’s coverage in upcoming debates around CHIP funding, repeal and replacement of the ACA, and Medicaid restructuring.

  • Insurance Coverage Changes for People with HIV Under the ACA

    Issue Brief

    This brief provides the first national estimates of changes in insurance coverage among people with HIV since the implementation of the ACA. We find that coverage increased significantly for people with HIV due to the ACA’s Medicaid expansion; indeed, increased Medicaid coverage in expansion states drove a nationwide increase in coverage for people with HIV.

  • ACA Medicaid Expansion Drove Nationwide Increase in Health Coverage for People with HIV, First National Analysis Finds

    News Release

    As Congress moves to repeal the Affordable Care Act, a new analysis from the Kaiser Family Foundation provides the first national estimates of changes in health coverage for people with HIV since the law was implemented. It finds that rolling back the law’s Medicaid expansion could significantly impact coverage for people with HIV. Nationwide, Medicaid coverage for people with HIV in care rose six percentage points between 2012 to 2014, when ACA coverage expansions took…

  • The Republican Health-care Plan the Country Isn’t Debating

    From Drew Altman

    In this Washington Post op-ed, Drew Altman discusses how Republicans' ideas to change Medicaid and Medicare and repeal the Affordable Care Act would fundamentally change the federal role in health, calling it: the biggest change in health we are NOT debating.

  • Do You Have the Facts About Medicare’s Financial Outlook for the Future?

    News Release

    Medicare is likely to be back on the federal policy agenda this year as Congress and President Trump pursue repealing and replacing the Affordable Care Act, and potentially consider options to reduce federal spending. When talking about Medicare, the nation’s federal health insurance program for 57 million people age 65 and over and younger people with disabilities, some policymakers often express concern that the program will soon be “bankrupt” and that rising spending is unsustainable.…

  • 10 Essential Facts About Medicare’s Financial Outlook

    Issue Brief

    Medicare, the nation’s federal health insurance program for 57 million people age 65 and over and younger people with disabilities, often plays a major role in federal health policy and budget discussions. Medicare is likely to be back on the federal policy agenda as Congress debates repealing and replacing the ACA, and also if policymakers turn their attention to reducing entitlement spending as part of efforts to reduce the growing federal budget deficit and debt.…

  • Early Implementation Experience of Medicaid Expansion Waivers in Michigan and Indiana Can Help Inform Future Medicaid Waivers

    News Release

    Michigan and Indiana, led by Republican governors, each obtained a waiver from the Obama Administration to expand Medicaid in ways that differ from the terms of the Affordable Care Act. Notably, both states’ expansions include provisions related to charging enrollees premiums, requiring them to contribute to health accounts and providing incentives to participate in healthy behavior programs, though the details and implementation vary considerably between the two states. A new analysis from the Kaiser Family…

  • Key Questions About Medicaid Block Grants

    News Release

    As policymakers in Washington discuss Affordable Care Act repeal and a possible block grant for Medicaid, a new issue brief from the Kaiser Family Foundation lays out key questions to consider in restructuring federal financing of the nation’s health insurance program for low-income Americans. Capping federal funding for Medicaid through a block grant or a per capita cap financing system would make federal spending more predictable and achieve federal budget savings. It also could be structured…

  • 5 Key Questions: Medicaid Block Grants & Per Capita Caps

    Issue Brief

    Medicaid covers more than 70 million low-income children, pregnant women, adults, seniors, and people with disabilities in the United States. The program represents $1 out of every $6 spent on health care in the US and is the major source of financing for states to provide coverage for the health and long-term needs of low-income residents. President Trump and other GOP leaders have called for fundamental changes in the structure and financing of Medicaid. This…