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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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  • 2021 Premium Changes on ACA Exchanges and the Impact of COVID-19 on Rates

    Issue Brief

    This brief summarizes premium rate filings in all 50 states and the District of Columbia and finds the majority of rate changes for 2021 are moderate, with increases or decrease of a few percentage points. Insurers say the COVID-19 pandemic is putting both upward and downward pressure on health costs in 2021.

  • Poll: Strong Initial Support for a Public Option, But Arguments Can Significantly Shift Views

    News Release

    Health Care Remains a Top Issue for Democrats Heading into Next Debates; At This Stage, More Want to Hear About Candidates’ Difference than Contrasts with President Trump The 2020 presidential election may be shaping up to be another election cycle focused on health care, with Democratic candidates offering competing proposals aimed at expanding coverage and controlling costs and a pending legal battle over the constitutionality of the Affordable Care Act. The latest KFF tracking poll…

  • The Democratic Debates Suffer from a Nasty Case of Plan-itis

    From Drew Altman

    In The Washington Post op-ed “The Democratic Debates Suffer from a Nasty Case of Plan-itis,” Drew Altman says the primary debates are not serving voters well by focusing on details of candidates' health care plans rather than the fundamental differences between them.

  • ¿Puede mi iglesia (o un familiar o tercera parte) pagar mi parte de la prima mensual de mi seguro por mí?

    FAQs

    Familiares pueden realizar pagos de primas y costos compartidos en nombre de los afiliados por el Programa Ryan White de VIH/SIDA, otros programas gubernamentales federales y estatales que brindan apoyo para primas y costos compartidos para personas específicas, naciones u organizaciones nativas. Las reglas federales disuaden a los planes del mercado de aceptar pagos de terceros de hospitales, otros proveedores de atención médica y otras entidades comerciales. Consulte con su plan de salud para obtener…

  • Poll: Just Over Half of the Nation’s Workforce Have Lost a Job or Income Due to Coronavirus, though Most of Them Believe They Will Get Their Job and Income Back Within Six Months

    News Release

    With many businesses shut down and job losses mounting nationwide, just over half of the nation’s workers (55%) now say they have lost a job or had their incomes reduced as a result of the health and economic crises sparked by the novel coronavirus pandemic, the latest KFF Health Tracking poll finds. This includes a quarter (26%) of all those who were working on Feb. 1 who say they lost a job and another 7%…

  • Joe Biden’s New Health Care Agenda (and CMS’s Big Role In It)

    From Drew Altman

    With the Georgia runoff elections giving Democrats control of the U.S. Senate, Drew Altman discusses President-elect Biden’s potential health care agenda and suggests that the Centers for Medicare & Medicaid Services could have an expanded role and that it may be time to rename it and elevate it to a cabinet agency.

  • Health Insurer Financial Performance Through September 2020

    Issue Brief

    In this brief, we analyze third quarter data from 2018 to 2020 to examine how insurance markets performed financially through the end of September. Average margins remained relatively high compared to the same point in recent years, suggesting many insurers remained profitable even as non-COVID-related care returned in the summer and fall.

  • For 3rd Year in a Row, More Insurers are Entering the ACA Marketplaces, Creating More Options for Consumers

    News Release

    For the third straight year, more insurers are entering the Affordable Care Act’s marketplaces and expanding their service areas, creating more options for consumers seeking to buy their own insurance for 2021, a new KFF analysis finds.  The analysis finds 30 insurers joining the marketplace across 20 states, and another 61 insurers are expanding their services within states that they already served. More than a third of counties (1,207, or 38%) will have more insurers…