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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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  • Improving the Affordability of Coverage through the Basic Health Program in Minnesota and New York

    Issue Brief

    To date, Minnesota and New York are the only states to have adopted a Basic Health Program (BHP), an option in the Affordable Care Act (ACA) that permits state-administered coverage in lieu of marketplace coverage for those with incomes below 200% of the federal poverty level (FPL) who would otherwise qualify for marketplace subsidies. BHP covers adults with incomes between 138-200% of FPL and lawfully present non-citizens with incomes below 138% FPL whose immigration status…

  • What’s at Stake in a Potential Repeal of the ACA Medicaid Expansion?

    News Release

    President-elect Trump and Republican leaders in Congress have vowed to repeal the Affordable Care Act (ACA) and replace it with an alternative plan. There are now 32 states (including DC) that have adopted the ACA’s Medicaid expansion. While the details of a repeal-and-replace plan are not yet available to assess its impact, a new brief reveals what’s potentially at stake for Medicaid in the debate by examining the changes in health coverage and financing that…

  • How the Republican Health Agenda Could Play Out

    From Drew Altman

    In this Wall Street Journal Think Tank column Drew Altman discusses how Republicans will assume ownership of health care’s policy and political problems as they assume control, and how that may affect their plans for the Affordable Care Act, Medicaid and Medicare.

  • After the Election, the Public Remains Sharply Divided on Future of the Affordable Care Act

    News Release

    Among Those Who Favor Repeal, Arguments About Loss of Coverage for Those with Pre-Existing Conditions Can Sway Some Opinions Many Obamacare Provisions Remain Broadly Popular Across Party Lines, But Not its Mandate The first Kaiser Health Tracking Poll since the 2016 election finds that Americans are largely divided on the future of the Affordable Care Act even though many of the law’s major provisions remain quite popular across party lines. The new survey finds that…

  • Kaiser Health Tracking Poll: November 2016

    Feature

    The November Kaiser Health Tracking Poll, conducted one week after the 2016 presidential election, finds health care played a limited role in voters’ 2016 election decisions. While President-elect Trump and Republican lawmakers have made it clear that one of their top priorities is the repeal of the Affordable Care Act, the survey finds Americans are divided on what they want to see lawmakers do to the health care law. This survey also finds that many…

  • Key Medicaid Questions Post-Election

    Fact Sheet

    This fact sheet provides insight into how a repeal of the Affordable Care Act (ACA) and changes in the financing structure would affect Medicaid, including the Medicaid expansion, and how a Trump administration could change Medicaid through administrative actions.

  • The Bigger Story, and Agenda, Behind GOP Changes to Obamacare, Medicare and Medicaid

    From Drew Altman

    This column was published as a Wall Street Journal Think Tank column on November 21, 2016. Early media coverage of the Republican health-care agenda has concentrated on plans to repeal and then replace the Affordable Care Act. The larger story is GOP preparations for a health policy trifecta: to fundamentally change the ACA, Medicaid and Medicare–all three of health care’s major programs–and in the process, fundamentally alter the direction of the federal role in health and core elements…

  • Women's Health Coverage promo

    How Does Where You Work Affect Your Contraceptive Coverage?

    Interactive

    The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for a broad range of preventive services including FDA approved prescription contraceptives and services for women. Legal challenges and recently issued rules have affected contraceptive coverage for many women.