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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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  • 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…

  • Listening to Trump Voters with ACA Coverage: What They Want in a Health Care Plan

    Issue Brief

    President Donald Trump and Republicans in Congress are moving to follow through on their campaign promise to repeal and replace the Affordable Care Act (ACA). To gain a better understanding of the personal experiences of Trump voters with health coverage provided through the ACA and the changes they hope to see in the health system moving forward, the Kaiser Family Foundation (KFF) held focus groups in December 2016 with Trump voters in cities in three…

  • What is at Stake for Health and Health Care Disparities under ACA Repeal?

    Issue Brief

    This brief describes health and health care disparities today, highlights recent advancements in reducing disparities under the Affordable Care Act (ACA), and discusses how the American Health Care Act (AHCA) and proposed reductions in discretionary funding may affect ongoing efforts to address disparities.

  • Snapshot of Where Hillary Clinton and Donald Trump Stand on Seven Health Care Issues

    Issue Brief

    Where do the 2016 Presidential candidates, Hillary Clinton and Donald Trump, stand on key health care issues? This snapshot outlines the candidates' positions and policy statements on issues such as health insurance, the ACA, Medicaid, Medicare, the opioid epidemic, prescription drug costs, women's reproductive health, and Zika.

  • Kaiser Health Tracking Poll: September 2016

    Report

    The September Kaiser Health Tracking Poll takes a look at the public's attitudes on several major health policy issues including prescription drugs costs and the ACA. In addition, the poll explores how important health care issues are to voters during the 2016 presidential election.

  • Visualizing Health Policy: Intersection of State Abortion Policy and Clinical Practice

    Other Post

    This Visualizing Health Policy infographic examines state policies related to abortion and their intersection with clinical practice. Nine of 10 reported abortions in the United States are in the first trimester. Between 2003 and 2012, the abortion rate decreased 18% among women aged 15 to 44 years. Twenty-five states have laws that restrict insurance coverage of abortion in private plans. Twenty-seven states require women seeking abortion to wait 18 hours or more before obtaining an…

  • Visualizing Health Policy: Intersection of State Abortion Policy and Clinical Practice

    News Release

    This Visualizing Health Policy infographic examines state policies related to abortion and their intersection with clinical practice. Nine of 10 reported abortions in the United States are in the first trimester. Between 2003 and 2012, the abortion rate decreased 18% among women aged 15 to 44 years. Twenty-five states have laws that restrict insurance coverage of abortion in private plans. Twenty-seven states require women seeking abortion to wait 18 hours or more before obtaining an…

  • Evolving Picture of Nine Safety-Net Hospitals: Implications of the ACA and Other Strategies

    Issue Brief

    Safety-net hospitals are an integral part of the U.S. health care landscape, providing care to some of the nation’s most medically vulnerable populations, including Medicaid enrollees and the uninsured. With the implementation of the Affordable Care Act (ACA), the U.S. health care system is rapidly changing, and safety-net hospitals need to make major adjustments to survive in the post-reform environment. This brief draws on interviews with executives at nine safety-net hospital systems and examines how…

  • New Analysis Finds US Individual Insurance Market Grew 46 Percent in First Full Year of Affordable Care Act

    News Release

    A new analysis from the Kaiser Family Foundation finds that the nation's individual insurance market grew 46 percent to 15.5 million people in the first year plans could be purchased through the Affordable Care Act's marketplaces, which offer premium assistance to low- and moderate-income people. Four states -- California, Florida, Texas and Georgia -- accounted for almost half of the enrollment growth. In six states, the number of people covered in the individual market increased…

  • Five Ways the Graham-Cassidy Proposal Would Affect Women

    Fact Sheet

    The Graham-Cassidy Senate proposal to repeal and replace the Affordable Care Act that could have a far-reaching impact on women's health care access and coverage. A new fact sheet outlines the ways women could be affected.