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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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  • Estimating Federal Payments and Eligibility for Basic Health Programs: An Illustrative Example

    Report

    In some states, policymakers and stakeholders are considering adoption of the Basic Health Program (BHP) option permitted under the Patient Protection and Affordable Care Act (ACA). Federal regulations allow BHP implementation beginning in 2015. Through BHP, consumers with incomes at or below 200 percent of the federal poverty level (FPL) who would otherwise qualify for subsidized qualified health plans (QHPs) offered in health insurance marketplaces instead are offered state-contracting standard health plans that provide coverage…

  • Mapping Marketplace Enrollment

    Interactive

    This interactive zip code tool and map displays enrollment in the Health Insurance Marketplaces as a share of the potential market in small geographic areas across the country.

  • Facing the Fallout From a King v. Burwell Ruling

    From Drew Altman

    With a Supreme Court decision on King v. Burwell looming, this Drew Altman column for The Wall Street Journal’s Think Tank plays out the politics of a ruling for the two major parties.

  • Media Availability on the U.S. Supreme Court’s King v. Burwell Decision

    Event Date:
    Event

    The Kaiser Family Foundation held a media-only conference call with key experts on the Affordable Care Act (ACA), state marketplaces and more to explain the U.S. Supreme Court's decision in the King v. Burwell case and to answer questions about its implications. The petitioners in the case are challenging the legality of premium and cost-sharing subsidies for low- and middle-income people buying health plans in 34 states where the federal government rather than the state…

  • After King v. Burwell Ruling, Health Law Issues Involve Implementation

    News Release

    After today’s Supreme Court ruling upholding the Affordable Care Act’s federal subsidies, Drew Altman's latest column in The Wall Street Journal's Think Tank explores what the decision means and what’s next for the health law. All previous columns by Drew Altman are available.

  • How Have Insurers Fared Under the Affordable Care Act?

    Perspective

    This analysis tracks the financial performance of insurers in the individual market by evaluating trends in the medical loss ratio (MLR) in the pre-ACA landscape from 2010 to 2013 and estimates the MLR for the first full year of Affordable Care Act implementation in 2014. Findings suggest that although performance varied among insurers, insurers overall had roughly comparable financial performance in 2014 as in recent prior years.

  • Updated for 2015: Tool Displays By Locality the Share of Potential ACA Federal Marketplace Enrollees That Signed Up

    News Release

    An interactive tool from the Kaiser Family Foundation is now updated with 2015 data, allowing users to view on a local level the share of potential enrollees who signed up for a health plan in a federally-based marketplace under the Affordable Care Act. With Mapping Marketplace Enrollment, users can also compare the number of potential and actual enrollees – and the percentage that signed up for a plan -- in 2014 and 2015 within 100,000-resident…

  • Medicaid Expansion Spending and Enrollment in Context: An Early Look at CMS Claims Data for 2014

    Issue Brief

    This issue brief analyzes spending and enrollment data made available by CMS through the MBES. It breaks out spending and enrollment for the new adult group (Group VIII) that gained coverage in states that adopted the ACA Medicaid expansion. It looks at spending and enrollment for the new adult group in calendar year 2014, putting such data in the context of overall Medicaid spending and enrollment and examines trends across expansion states.

  • Health Insurance Marketplace Calculator Updated for 2016

    News Release

    The Kaiser Family Foundation's Health Insurance Marketplace Calculator is now updated to include local data on 2016 health plans that are being sold through the Affordable Care Act marketplaces. The Spanish-language version of the calculator is also updated.