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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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  • Health Care Ranks Among Voters’ Top Issues for the 2018 Midterm Elections, But It’s a Lower Priority Among Voters in Battleground States and Districts

    News Release

    Only One in Three Know the Tax Reform Law Repeals the ACA’s Unpopular Individual Mandate Health care and the economy and jobs top voters’ list as “the most important issue” for Congressional candidates to talk about ahead of November’s midterm elections, but the lineup shifts among voters in states and districts with competitive elections, the January Kaiser Health Tracking Poll finds.  When asked how important a series of major national issues are, similar shares say…

  • Association Health Plans for Small Groups and Self-Employed Individuals under the Better Care Reconciliation Act

    Issue Brief

    A provision in the Senate Better Care Reconciliation Act (BCRA), a bill to repeal and replace the Affordable Care Act (ACA), would establish association health plan options for small employers and self-employed individuals. For these plans, the requirement that premiums cannot vary based on health status would not apply. This brief describes how association health plans could affect premiums in the small group and non-group markets.

  • Section 1332 State Innovation Waivers: Current Status and Potential Changes

    Issue Brief

    Section 1332 of the Affordable Care Act (ACA) authorizes states to waive key requirements under the law in order to experiment with different health coverage models. As Republicans in Congress debate repeal and replacement of the ACA, renewed attention is being paid to these waivers as a mechanism for giving states flexibility to restructure their health care markets. This brief describes current 1332 waiver activity, including proposals in the Senate's Better Care Reconciliation Act (BCRA),…

  • What Are the Implications for Medicare of the American Health Care Act and the Better Care Reconciliation Act?

    Issue Brief

    This issue brief highlights a major implication of the American Health Care Act and Better Care Reconciliation Act for Medicare. Both bills would repeal the Affordable Care Act provision to increase the payroll tax on high-income earners. Repealing this surtax would move up the insolvency date of the Medicare Part A trust fund by 2 years, from 2028 to 2026, and also worsens the program's long-term financial outlook.

  • Senate Health Bill Proposes Big Changes to Medicaid Beyond Repealing and Replacing the ACA

    News Release

    The Better Care Reconciliation Act (BCRA) under consideration in Congress includes provisions that would fundamentally change Medicaid by phasing out extra federal funding for states’ Medicaid expansions and for the first time limiting federal spending on Medicaid through a per enrollee cap on financing or a block grant for certain adults. While those measures account for most of the bill’s $756 billion reduction in federal Medicaid spending over the next decade, there are other big…

  • The ACA Stability “Crisis” In Perspective

    From Drew Altman

    In this column for Axios, Drew Altman presents new data analysis showing how many people are impacted by premium increases in the non-group market, and discusses the implications. 

  • Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors

    Issue Brief

    This brief explains three provisions of the Affordable Care Act (ACA) – risk adjustment, reinsurance, and risk corridors – that were intended to promote insurer competition on the basis of quality and value and promote insurance market stability, particularly in the early years of reform as the ACA marketplaces, also known as exchanges, were established.