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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

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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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  • There is No Drop-Dead Date for an ACA Tax Credit Extension, But Coverage Losses Will Mount as the Clock Ticks

    Quick Insights

    While the Affordable Care Act’s enhanced premium tax credits expired at the end of 2025, there is no absolute drop-dead date for extending them. An extension could happen even after the deadline to sign up for coverage and be made retroactive to January 1. Open enrollment could also be extended to allow people time to change their plans or allow new people to sign up. ACA enrollees would welcome premium relief whenever it comes.

  • Health Affairs Article: Medicaid Expansion Under Health Reform May Increase Service Use and Improve Access For Low-Income Adults With Diabetes

    Issue Brief

    This analysis finds that Medicaid’s role in financing diabetes care will grow when many low-income uninsured people with diabetes become eligible for Medicaid as the program expansions under the Affordable Care Act in 2014. Adult Medicaid beneficiaries with diabetes had annual per person health expenditures more than three times higher than adult beneficiaries without the disease -- $14,229 versus $4,568, according to the study. At the same time, many uninsured adults with diabetes are less…

  • Who Will be the H&R Block and TurboTax for Health Insurance?

    Perspective

    There's been quite a bit of focus lately insofar as these issues go, anyway on health insurance agents and brokers (sometimes known in the industry as "producers"). They are pushing legislation that has been introduced in Congress and is now being studied by the National Association of Insurance Commissioners that would exempt agent and broker commissions for health insurance from minimum medical loss ratio (MLR) thresholds established in the health reform law. (The MLR is…

  • The Budget: What Would You Cut?

    Perspective

    As President Obama and Congress begin to hash out the 2012 budget, it is a good time to revisit results from our January 2011 survey showing that in spite of the fact that most Americans report being very concerned about the budget deficit, there is little public support for major reductions across a number of program areas. Majorities said they would not support any reductions in Social Security (64 percent), public education (63 percent), or…

  • How the ACA Changes Pathways to Insurance Coverage for People with HIV

    Perspective

    There are multiple sources of insurance coverage and care for people with HIV in the United States.  These include public programs, such as Medicaid and Medicare, and the Ryan White HIV/AIDS program, as well as private coverage through an employer or in the individual market. Medicaid, the nation's principal safety-net health insurance program for low-income Americans, is estimated to cover the largest share of people with HIV. Fewer are covered by Medicare, the federal health…

  • A Medicaid Block Grant Would Reduce Federal Spending But Trigger Substantial Cuts in Medicaid Coverage in the States That Would Increase the Uninsured

    News Release

    NEWS RELEASEMay 10, 2011 New State-By-State Analysis Shows House Budget Plan For Medicaid Would Reduce Enrollment By Tens of Millions Of People And Cut Funding For Hospitals And Other Medicaid Services WASHINGTON, D.C. -- Converting Medicaid into a block grant and repealing the health reform law as adopted by the House last month in a party-line vote would trigger major reductions in program spending and enrollment compared to current projections, a shift with big implications…

  • Mapping Premium Variation in the Individual Market

    Issue Brief

    This analysis examines how premiums for individual health insurance differ around the nation, finding that premiums can vary substantially from state to state. The average per-person premium in 2010 ranged in cost from approximately $136 per month in Alabama to more than $400 per month in Vermont and Massachusetts. The average across all states was $215 per member per month. Given the fragmentation of the market and the lack of public data available about individual…

  • Quick Take: Timing Matters: States Waiting for a Supreme Court Decision to Plan an Exchange

    Fact Sheet

    State-based health insurance exchanges are an important component of the Patient Protection and Affordable Care Act (ACA) designed to extend subsidized private health insurance coverage to millions of Americans by 2014. Though projections show exchange enrollment could grow to 20 million individuals nationally, aggressive planning on the part of states will be necessary to meet implementation timelines—exchanges must be fully operational by January 1, 2014 and the Department of Health and Human Services will begin…

  • State Exchange Profiles: Utah

    Other Post

    Final update made on May 21, 2013 (no further updates will be made)  Establishing the Exchange After making health system reform one of the state’s top policy priorities, Utah’s former Governor Jon Huntsman (R) signed legislation in 2008 (HB 133) and 2009 (HB 188) which directed the Office of Consumer Health Services to create the Utah Health Exchange.1  Current Governor Gary Herbert (R) signed into law additional legislation amending provisions related to health system reform in…

  • State Exchange Profiles: Indiana

    Other Post

    Final update made on December 13, 2012 (no further updates will be made)  Establishing the Exchange In November 2012, Governor-elect Mike Pence (R) announced that he would not move forward with setting up a state-based health insurance exchange when he takes office in 2013.1 During his term, Governor Mitch Daniels (R) had signed Executive Order #11-01 in 2011 to conditionally establish and operate the Indiana Insurance Market, Inc., a nonprofit corporation to serve as the…