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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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  • Among People Ineligible for Subsidies, Middle-Class Older Adults Face the Least Affordable ACA Premiums, Especially Those Living in Rural Areas Where Premiums Are Highest

    News Release

    A new KFF analysis finds that Affordable Care Act marketplace premiums are least affordable for older adults who earn too much to qualify for federal subsidies, especially those living in rural areas where premiums are highest. The analysis of the lowest-cost 2019 ACA marketplace plans across U.S. counties finds that older adults not eligible for subsidies living in 28 rural Nebraska counties face the least affordable ACA premiums as a share of income. A 60-year-old…

  • KFF Health Tracking Poll – April 2019: Surprise Medical Bills and Public’s View of the Supreme Court and Continuing Protections for People With Pre-Existing Conditions

    Feature

    The April 2019 KFF Health Tracking Poll examines the public’s position on the future of ACA and its protections for people with pre-existing medical conditions, in light of the ongoing legal battle which may end up in the Supreme Court. With lawmakers proposing legislation to address surprise medical bills, this month’s survey also measures the public’s support for federal government action to protect patients from having to pay the cost incurred from an inadvertent out-of-network…

  • Survey on the Role of Health Care Interest Groups –Toplines

    Poll Finding

    These toplines are of a survey conducted jointly by NPR, the Kaiser Family Foundation, and the Harvard School of Public Health examines the public’s views and opinions of the role of health care interest groups in the ongoing federal health care debate. The survey examines whether people feel their views are represented in the ongoing legislative process and their level of trust in different groups. The survey is part of a series of projects about…

  • Expanding Medicaid under Health Reform: A Look at Adults at or below 133% of Poverty

    Issue Brief

    This issue brief from the Kaiser Commission on Medicaid and the Uninsured examines the key characteristics of the 17.1 million low-income uninsured adults who currently have incomes that would qualify them for Medicaid under the expansion of the program in health reform. The planned expansion of Medicaid to all individuals with incomes at or below 133 percent of the federal poverty level will establish a national foundation of coverage based on income. Adults whose incomes…

  • The Affordable Care Act: Three Years Post-Enactment

    Issue Brief

    On March 23, 2010, the Affordable Care Act (ACA) was signed into law. Although the date for full implementation of most provisions of the law is January 1, 2014, the ACA has already led to progress toward expanded coverage of the uninsured; improved access and better care delivery models; broader access to community-based long-term care; and more integrated care and financing for beneficiaries who are dually eligible for Medicare and Medicaid. The brief provides an…

  • How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports (LTSS) Today? State Adoption of Six LTSS Options

    Issue Brief

    Under the Affordable Care Act (ACA), states are afforded a number of new and expanded opportunities, including enhanced federal financing, to improve access to and delivery of Medicaid long-term services and supports (LTSS). This policy brief provides an overview of six key Medicaid LTSS options created or enhanced by the 2010 law and state adoption of these options to date. Nearly every state (47 states and DC) has taken steps forward with at least one…

  • How Will Consumers Navigate New Health Care Options? Briefing and Panel Discussion

    Event Date:
    Event

    With the open enrollment period for health insurance exchanges less than six months away, consumers are already asking questions about their new health care options under the Affordable Care Act (ACA). Even in the age of digital information, hands-on consumer assistance could play a key role in helping people understand their insurance choices come 2014 — a recent Kaiser Family Foundation poll showed that two thirds of the uninsured and a majority of Americans overall…

  • Health Coverage by Race and Ethnicity: The Potential Impact of the Affordable Care Act

    Issue Brief

    Executive Summary One of the key goals of the Affordable Care Act (ACA) is to reduce the number of uninsured through a Medicaid expansion and the creation of health insurance exchange marketplaces with advance premium tax credits to help moderate-income individuals pay for this coverage. Given that people of color are at disproportionate risk of being uninsured and having low incomes, the ACA coverage expansions could particularly benefit communities of color and advance efforts to…

  • State Marketplace Profiles: New Hampshire

    Other Post

    Final update made on November 1, 2013 (no further updates will be made) Establishing the Marketplace On June 18, 2012, Governor John Lynch (D) signed HB 1297 into law, which prohibits the state from participating in or enabling a state-based health insurance Marketplace. However, HB 1297 allows for state agencies or departments to “operate specific functions of a federally-facilitated exchange."1  Given this authority, newly-elected Governor Maggie Hassan (D) informed federal officials on February 13, 2013 that…

  • State Exchange Profiles: Montana

    Other Post

    Final update made on April 19, 2013 (no further updates will be made) Establishing the Exchange In December 2012, Montana’s elected State Auditor Monica Lindeen (D) confirmed that the federal government would operate a health insurance exchange in Montana.1 The previous year, two proposed bills (HB620 and HB124) to establish a health insurance exchange in Montana failed.2,3 Instead, the legislature passed SB 228, a bill that would prohibit the creation of a health insurance exchange as proscribed…