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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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  • State Flexibility to Address Health Insurance Challenges under the American Health Care Act, H.R. 1628

    Issue Brief

    The American Health Care Act (AHCA), a bill passed by the House in May 2017 to repeal and replace the Affordable Care Act (ACA), would present states with new authority in individual insurance markets, along with a number of difficult problems and choices and limited resources with which to address them. States would be able to obtain waivers and would be eligible for $123 billion in grant funds, including money from a new Patient and…

  • Coronavirus Response and the Affordable Care Act

    Policy Watch

    This post examines the Affordable Care Act's impact 10 years after its enactment and how its provisions, especially those that expand coverage opportunities, could address the health threat and economic upheaval caused by the coronavirus pandemic.

  • KFF Health Tracking Poll – Early April 2020: The Impact Of Coronavirus On Life In America

    Report

    Fielded from March 25-30, this poll tracks how the rapidly unfolding coronavirus (COVID19) pandemic is affecting Americans, including health and economic impacts to date and worries about the future. This poll also examines the implications of the pandemic on the 2020 presidential election, including favorability of the ACA, Medicare-for-all and a public option.

  • 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.

  • Assessing the Performance of the U.S. Health System

    Issue Brief

    Health spending growth has consistently outpaced U.S. economic growth and is higher than medical spending in other wealthy countries. Despite spending more, the United States doesn't have better health outcome in terms of life expectancy, mortality rates and other measures. This brief provides an overview of trends in health costs and the performance of the U.S. health system, including comparisons to countries from the Organisation for Economic Co-operation and Development (OECD). The brief charts growth…

  • Majority Favors the Affordable Care Act’s Employer Mandate, But Opinion Can Shift When Presented With Pros and Cons

    News Release

    Recent news stories on the heath law did not attract most Americans’ attention, and many are unaware of details and implications of the developments Weeks before the Affordable Care Act’s employer mandate takes effect in January, a new Kaiser Family Foundation tracking poll finds that six in 10 Americans (60%) say they have a favorable view of the provision, which in 2015 requires employers with 100 or more full time workers to offer health coverage…

  • New Policy Insight Examines Medical Debt Among Insured Consumers

    News Release

    In this new policy insight, Kaiser Family Foundation Senior Fellow Karen Pollitz explores how high cost sharing in health insurance plans can contribute to an individual’s medical debt, and explains how greater transparency in plan details could help consumers avoid some financial pitfalls. Medical Debt Among Insured Consumers: The Role of Cost Sharing, Transparency, and Consumer Assistance also provides an update on provisions of the Affordable Care Act meant to increase health plan transparency and…

  • Questions About Essential Health Benefits

    Perspective

    The Institute of Medicine (IOM) recently issued its long-awaited report on defining the essential health benefits under the Affordable Care Act (ACA). As expected, the committee preparing the IOM report did not recommend which specific services should be covered, but rather discussed what the process should be for defining the essential benefits, which all insurers selling coverage to individuals and small businesses will have to provide beginning in 2014. Somewhat unexpected was their recommendation to set a…