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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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  • 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…

  • Analysis: Before ACA Benefits Rules, Care for Maternity, Mental Health, Substance Abuse Most Often Uncovered by Non-Group Health Plans

    News Release

    Three in four health plans in the non-group insurance market did not cover delivery and inpatient maternity care in 2013, before the Affordable Care Act (ACA) essential health benefits requirement took effect, finds a new Kaiser Family Foundation analysis. Other major benefits most often left uncovered before the ACA include substance abuse disorder services (inpatient and outpatient services each not covered by 45% of 2013 non-group plans) and mental/behavioral health services (inpatient and outpatient services…

  • The Impact of the Children’s Health Insurance Program (CHIP): What Does the Research Tell Us?

    Issue Brief

    The Children’s Health Insurance Program (CHIP) was established in 1997 to provide coverage for uninsured children who are low-income but above the threshold for Medicaid eligibility. In 2009, and again in the Affordable Care Act (ACA), Congress extended federal funding for CHIP, but funding will expire a little over a year from now. Decisions about CHIP’s future funding will be consequential as more than 8 million low-income children were covered by CHIP at some point…

  • The Stakes Beyond the Halbig Lawsuit

    From Drew Altman

    In a column for The Wall Street Journal’s Think Tank, Drew Altman discusses if the legal court cases about whether the government can provide tax credits to people in the Affordable Care Act’s federal health exchanges will be perceived by the American people as a legitimate legal question or as more inside-Washington politics.

  • Medicaid Health Homes: A Profile of Newer Programs

    Issue Brief

    Under the ACA, states have a new Medicaid option to establish "health homes" designed to improve care coordination and integration and reduce costs for beneficiaries with chronic conditions. Thus far, 15 states have implemented health home programs. Following on a 2012 brief profiling Medicaid health home programs in the first six states to adopt the option, this brief describes the health home programs in the nine states that have implemented them since that time, and…

  • How Obamacare Is Doing Better But Feeling Worse

    From Drew Altman

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman explains why even as there are recent positive indicators of the Affordable Care Act’s performance and impact, public opinion about the law has not changed since passage of the law.