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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

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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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  • What a Break in the Obamacare Battles Could Bring

    From Drew Altman

    Following the Supreme Court’s King v. Burwell decision, the Affordable Care Act could use a break from the intense political heat, though it may not get a long one as the 2016 election season heats up and presidential candidates play to their bases on health care, writes Drew Altman in his latest column for The Wall Street Journal’s Think Tank.

  • Measles Outbreak and Vaccination Debate Capture Public’s Attention

    News Release

    Those Following Measles Story More Likely To Say They Worry About the DiseaseThe public paid more attention to news coverage of the measles outbreak in the U.S. and the resulting debate on whether vaccinations should be required for all kids than any other news story included in this month's Kaiser Health Policy News Index. A total of 70 percent of Americans say they closely followed the measles story, more than say the same about the…

  • Coverage of Contraceptive Services: A Review of Health Insurance Plans in Five States

    Report

    The Patient Protection and Affordable Care Act (ACA) requires most private plans to provide coverage for women’s preventive health care, including all prescribed FDA-approved contraceptive services, without cost sharing. To better understand how this provision is being implemented by health plans, Kaiser Family Foundation (KFF) staff, with the Lewin Group, reviewed the insurance plan coverage policies for 12 prescribed contraceptive methods (excluding oral contraceptives). This report presents information from 20 different insurance carriers in five…

  • At Tax Time, No Public Backlash Over Obamacare’s Individual Mandate

    News Release

    As tax season closes, Drew Altman looks at why the ACA’s individual mandate and tax credit reconciliation process “passed their first major hurdles this tax season with no significant public backlash,” in his latest column for The Wall Street Journal's Think Tank.

  • Data Note: How Has the Individual Insurance Market Grown Under the Affordable Care Act?

    Issue Brief

    This data note examines changes in the individual insurance market under the Affordable Care Act. Through analysis of filings by insurers to state insurance departments, the Kaiser Family Foundation estimates that the number of people enrolled in the individual insurance market grew 40 percent from the end-of-year 2013 to the end-of-year 2014 and has likely continued growing in 2015 as well.

  • 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…

  • Minimum Contraceptive Coverage Requirements Clarified by HHS Guidance

    Issue Brief

    New HHS clarification on ACA contraceptive coverage requirement specifies that insurance plans must cover at no cost to women all of the 18 contraceptive methods approved by the FDA.  If a provider recommends a specific option or product, plans must cover it at no cost as well. Minimum Contraceptive Coverage Requirements Clarified by HHS GuidanceContraceptive MethodProducts/OptionsMust CoverSurgical sterilizationAlso called tubal ligation√Implant sterilizationOnly Essure available√Implantable RodMultiple√ at least 1IUD - CopperOnly ParaGard available√IUD - ProgestinMultiple√ at least 1InjectionMultiple√ at…

  • 2015 Survey of Health Insurance Marketplace Assister Programs and Brokers

    Report

    This nationwide survey analysis of Marketplace consumer assistance programs and brokers examines the nature of Marketplace assistance during the second open enrollment period for 2015 coverage, and offers unique insights into how Affordable Care Act (ACA) implementation is progressing, what is changing, and what challenges remain. Building upon our Survey of Health Insurance Marketplace Assister Programs (2014), the analysis compares Assister Program capacity and experiences from the first open enrollment period to the next, and…

  • The Connection Between Health Coverage and Income Security

    From Drew Altman

    In this column in The Wall Street Journal's Think Tank, Drew Altman shows how expanding health coverage and improving economic security for working Americans are connected even though they are often part of separate policy debates.

  • The Connection Between Health Coverage and Income Security

    News Release

    Using data from a new Kaiser Family Foundation panel survey following the uninsured in California who gained coverage since 2010, Drew Altman's latest column in The Wall Street Journal's Think Tank shows how expanding health coverage and improving economic security for working Americans are connected even though they are often part of separate policy debates. All previous columns by Drew Altman are available online.