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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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  • Sizing Up Exchange Market Competition

    Issue Brief

    This issue brief offers an early look into how competitive the health insurance exchanges (also called marketplaces) are under the Affordable Care Act in selected states. Through analysis of enrollment data released by seven states (California, Connecticut, Minnesota, New York, Nevada, Rhode Island, and Washington) this brief finds that exchange markets in California and New York are shaping up to be more competitive than their individual markets were in 2012 while those of Connecticut and…

  • Tax Subsidies for Private Health Insurance

    Issue Brief

    This brief describes the different forms of tax assistance for private health insurance, including subsidies offered through the Affordable Care Act's marketplaces and benefits for people who are self-employed or who have employer-based coverage. The brief also provides examples of how the subsidies work and how the amounts may differ by income and type of coverage.

  • Brief Provides Update on LGBT Coverage and Health as More States Recognize Same-Sex Marriage

    News Release

    An updated issue brief from the Kaiser Family Foundation gives a detailed profile of health concerns for lesbian, gay, bisexual and transgender individuals, offers the latest demographic data, and discusses the impact of recent changes in state and federal policies on health coverage, including the Affordable Care Act and same-sex marriage. As of this month, same-sex marriage is recognized in 32 states and the District of Columbia. The brief, Health and Access to Care and…

  • 10 FAQs: Medicare’s Role in End-of-Life Care

    Fact Sheet

    About eight of 10 of the 2.6 million people who died in the US in 2014 were people on Medicare, making Medicare the largest insurer of health care provided during the last year of life. These Frequently Asked Questions explain Medicare’s role in or coverage of end-of-life care, advance care planning, advance directives, and hospice care. They also provide information on Medicare spending on end-of-life care, changes to the physician fee schedule, and how related issues arose…

  • State-by-State Effects of a Ruling for the Challengers in King v. Burwell

    Interactive

    A map and table showing the number of people now receiving premium subsidies who would lose them if the Court finds for the challengers; the total amount of federal subsidy dollars; the average subsidy (or average premium tax credit) that subsidized enrollees have qualified for; and the average increase in premiums that subsidized enrollees would face if the subsidies are disallowed.

  • New Analysis Details Impact on Residents in Different States If the U.S. Supreme Court Rules for Challengers in King v. Burwell

    News Release

    The U.S. Supreme Court is expected to rule this month in the King v. Burwell case that challenges whether low- and moderate-income Americans are eligible for subsidies to help pay for insurance if they live in states where the federal government, rather than the state, established its new insurance marketplace under the Affordable Care Act (ACA). Using 2015 enrollment data released today, a new Kaiser Family Foundation analysis and interactive map breaks out how residents…

  • New Evidence Health Spending Is Growing Faster Again

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses new Census Department survey data showing higher health spending growth over the last four economic quarters, and raises the question: is the health spending slowdown over?