Affordable Care Act

The ACA MarketplaceS

How Has Marketplace Enrollment Changed Across States in 2026?

Following several years of rapid enrollment growth in the ACA Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the enhanced tax credits, generally saw lower drops in enrollment.

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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  • Amid Primary Debate about Universal Coverage, Most Democrats Now Want to Expand the Affordable Care Act, Leading to Somewhat Less Favorable Views of the Law Itself

    News Release

    Voters Rank Health Care Fourth As Issue for Presidential Candidates to Discuss With the Democratic presidential primary featuring a debate about how to get to universal health coverage in the United States, the latest Kaiser Health Tracking Poll finds most Democrats want Congress to expand the Affordable Care Act, contributing to a widening gap between unfavorable and favorable views of the health reform law. Overall the poll finds that this month 49 percent of the…

  • Kaiser Health Tracking Poll: April 2016

    Report

    The April Kaiser Health Tracking Poll examines the role of health care issues in the presidential election. Health care is one of the top four issues mentioned by voters when asked which issues they most want to hear candidates discuss in the campaign, but half as many cite health care as mention the economy and jobs. It also examines the public’s experiences with prescription painkiller abuse and access to mental health care, as well as…

  • JAMA Forum: Reports of Obamacare’s Demise Are Greatly Exaggerated

    Perspective

    In this post for The JAMA Forum, the Kaiser Family Foundation's Larry Levitt discusses UnitedHealth’s exit from Affordable Care Act marketplaces, the possibility of bigger premium increases in 2017, and why these challenges are unlikely to significantly affect long-term sustainability of the market and the law.

  • The Pennsylvania Health Care Landscape

    Fact Sheet

    The Affordable Care Act (ACA) went into full effect on January 1, 2014, ushering in health insurance reforms and new health coverage options in Pennsylvania and elsewhere across the country. Pennsylvania is experiencing changes to its health care delivery system as the state expands Medicaid, provides new coverage options through the federal health insurance marketplace, streamlines application and enrollment processes for coverage programs, and implements new health care delivery system and payment reforms. This fact…

  • Obamacare? Zika? Which Health Stories Americans Actually Follow

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman analyzes the Kaiser Health Policy News Index to determine which health stories in the news have broken through to the public the most in the last year. One conclusion: It wasn't the Affordable Care Act.

  • Obamacare? Zika? Which Health Stories Americans Actually Follow

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman analyzes the Kaiser Health Policy News Index to determine which health stories in the news have broken through to the public the most in the last year. One conclusion: it wasn't the Affordable Care Act.

  • Is ACA Coverage Affordable for Low-Income People? Perspectives from Individuals in Six Cities

    Issue Brief

    This brief presents findings from focus groups with low-income Medicaid and Marketplace enrollees in six cities: Baltimore, MD; Columbus, OH; Oakland, CA; Richmond, VA; St. Louis, MO; and Tampa, FL. It explores their experiences signing up for coverage; their perceptions of whether the costs they pay for their coverage are affordable; their experiences accessing care; and the impact of out-of-pocket costs on their ability to get needed care. It provides insights into the ongoing financial…

  • Analysis of UnitedHealth Group’s Premiums and Participation in ACA Marketplaces

    Issue Brief

    This analysis looks at how a potential withdrawal by UnitedHealth Group from the Affordable Care Act (ACA) marketplaces in 2017 could impact insurer competition and premiums, finding a significant impact in some markets, though it would have a minimal effect on the average benchmark premium nationwide, The impacts of a UnitedHealth withdrawal would vary considerably by state and market area, with a more pronounced effect in rural areas. Since UnitedHealth often is not one of…

  • Insurer Competition, Monthly Premiums Could Be Affected in Some Markets if UnitedHealth Group Exits ACA Marketplaces

    News Release

    A withdrawal by UnitedHealth Group from the Affordable Care Act (ACA) marketplaces in 2017 could have a significant impact on insurer competition and premiums in some markets, though it would have a minimal effect on the average benchmark premium nationwide, according to a new analysis from the Kaiser Family Foundation. Late last year, UnitedHealth announced that it experienced significant financial losses in ACA compliant plans and that it would decide about future participation in ACA…