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Affordable Care Act

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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  • Summary of the Affordable Care Act

    Fact Sheet

    This document summarizes the comprehensive 2010 health reform law, often called the Affordable Care Act or ACA, including changes made to it by subsequent legislation, with a focus on provisions to expand coverage, control costs, and improve delivery systems.

  • Health Care Access and Coverage for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community in the United States: Opportunities and Challenges in a New Era

    Perspective

    This Policy Insight looks at the challenges and questions surrounding recent policy changes that are expected to increase health insurance coverage and access to care for lesbian, gay, bisexual and transgender (LGBT) individuals and their families, including the impact of the Affordable Care Act (ACA) and the Supreme Court's DOMA decision.

  • Individual Insurance Market Performance in 2017

    Issue Brief

    This brief examines recently-released annual financial data from 2017 and finds insurers selling individual market plans had their best financially since 2014, when new ACA insurance market rules took effect that guaranteed access to coverage for people with pre-existing conditions. At the same time, recent political and policy changes, including the repeal of the individual mandate penalty as part of tax reform legislation and proposed regulations to expand loosely-regulated short-term insurance plans, cloud plans’ outlook…

  • The Health Care Views and Experiences of Rural Americans: Findings from the Kaiser Family Foundation/Washington Post Survey of Rural America

    Report

    In partnership with The Washington Post, the Kaiser Family Foundation conducted the Survey of Rural America to gauge the views and experiences of people living in small towns and rural areas across the United States, and how they are similar or different from those in urban and suburban settings. This brief explores where health care fits in rural residents' political views, including attitudes toward Republican plans to repeal and replace the ACA as well as…

  • Kaiser Family Foundation/Washington Post Partnership Survey Probes Experiences and Views of Rural Americans

    News Release

    Jobs Are Major Concern for Rural Residents: Two Thirds Rate Local Job Market as Fair or Poor, and Most Would Encourage Young People to Leave for Opportunities Elsewhere A new partnership survey of rural and small town America conducted by the Kaiser Family Foundation and The Washington Post gauges the views and experiences of people living in these communities and how they compare to those of urban and suburban residents. The survey finds that while…

  • Now Available: Summary of Senate Repeal/Replace Bill in 17 Key Areas

    News Release

    An interactive tool from the Kaiser Family Foundation now includes a detailed summary of the Senate’s new discussion draft, the Better Care Reconciliation Act, a plan released Thursday to repeal and replace the Affordable Care Act (ACA). With the tool, users can compare the Senate bill to current law and the House-passed American Health Care Act in 17 key areas of health policy, including Medicaid, premium subsidies to individuals, state role, financing, women’s health, and…

  • Medicaid’s Role in Colorado

    Fact Sheet

    This fact sheet provides data on Medicaid's role in Colorado. It describes how ending the enhanced match for Medicaid expansion and implementing a per capita cap or block grant would affect Colorado.