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The ACA MarketplaceS

How Has Marketplace Enrollment Changed Across States in 2026?

Following several years of rapid enrollment growth in the ACA Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the enhanced tax credits, generally saw lower drops in enrollment.

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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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  • An Estimated 52 Million Adults Have Pre-Existing Conditions That Would Make Them Uninsurable Pre-Obamacare

    News Release

    A new Kaiser Family Foundation analysis finds that 52 million adults under 65 – or 27 percent of that population -- have pre-existing health conditions that would likely make them uninsurable if they applied for health coverage under medical underwriting practices that existed in most states before insurance regulation changes made by the Affordable Care Act. In eleven states, at least three in ten non-elderly adults would have a declinable condition, according to the analysis:…

  • Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA

    Issue Brief

    This brief reviews medical underwriting practices by private insurers in the individual health insurance market prior to 2014, and estimates how many American adults could face difficulty obtaining private individual market insurance because of a pre-existing condition if the Affordable Care Act (also known as Obamacare) were repealed or amended and such practices resumed.

  • 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…