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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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  • 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…

  • Current Flexibility in Medicaid: An Overview of Federal Standards and State Options

    Issue Brief

    The Trump Administration and new Congress have indicated that they will seek to cap Medicaid financing through a block grant or per capita cap, reduce federal funding for the program, and offer states increased flexibility to manage their programs within this more limited financing structure. The size of the federal reductions as well as which federal program standards would remain in place and what increased flexibility might be provided to states under such proposals would…