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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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  • State Exchange Profiles: Louisiana

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    Final update made on December 13, 2012 (no further updates will be made) Establishing the Exchange Governor Bobby Jindal (R) announced that Louisiana will not pursue the establishment of a state-based health insurance exchange and instead will allow the federal government to operate an exchange in the state.1 While a bill establishing an exchange was introduced in the 2012 legislative session, it was not supported by the Governor and failed when the legislative session ended (SB…

  • State Marketplace Profiles: Colorado

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    Final update made on November 8, 2013 (no further updates will be made)  Establishing the Marketplace On June 1, 2011, Governor John Hickenlooper (D) signed SB 11-200 into law, establishing the Colorado Health Benefit Exchange.1  In January 2013, the Exchange announced that the online Marketplace would be called Connect for Health Colorado (C4HCO). Structure: The legislation defines Colorado’s Marketplace as a quasi-governmental organization, specifically a "nonprofit unincorporated public entity." Governance: The Marketplace is governed by a 12-member board.…

  • State Exchange Profiles: Alaska

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    Final update made on December 4, 2012 (no further updates will be made)  Establishing the Exchange On July 17, 2012, Governor Sean Parnell (R) announced that Alaska will not create a state-run health insurance exchange, and instead will allow the federal government to operate an exchange in the state.1 While a bill establishing an exchange was introduced in the 2011 legislative session and reconsidered in 2012, it failed to pass. Prior to the announcement that the…

  • State Exchange Profiles: South Dakota

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    Final update made on April 19, 2013 (no further updates will be made)  Establishing the Exchange On September 26, 2012, Governor Dennis Daugaard (R) announced that South Dakota would not establish an exchange.1However, the state intends to maintain regulatory authority over the health insurance market and perform the plan management function for the exchange.2 The decision to have a federally-facilitated exchange was made after an inter-agency work group and a taskforce of stakeholders and legislators explored…

  • State Exchange Profiles: Arizona

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    Final update made on December 4, 2012 (no further updates will be made) Establishing the Exchange  On November 28, 2012, Governor Jan Brewer (R) informed federal officials that Arizona would default to a federally-facilitated health insurance exchange.1 Prior to her decision to default, the Governor had established the Office of Health Insurance Exchange to “organize the health insurance marketplace for easier evaluation by individuals and small businesses to acquire affordable health insurance.”2 While legislation establishing a…

  • State Exchange Profiles: Alabama

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    Final update made on December 4, 2012 (no further updates will be made) Establishing the Exchange Despite previously supporting Alabama’s implementation of a state-based health insurance exchange, Governor Robert Bentley (R) announced on November 13, 2012, the state will default to a federally-facilitated exchange.1 Prior to the decision, Governor Bentley issued Executive Order 17 which created the Alabama Health Insurance Exchange Study Commission to recommend how Alabama should establish a health insurance exchange.2 The Governor appointed…

  • An Early Look at the Affordable Care Act and Women

    News Release

    On Thursday, May 15 at 9:30 a.m. ET, the Kaiser Family Foundation will host a public briefing to release a new report based on the Foundation’s most recent comprehensive survey on women’s health.  This report provides new findings that will be critical to understanding women’s early experiences with the coverage changes that are part of the Affordable Care Act, including the latest information on:  Private and public insurance coverage rates for women  Use of preventive…