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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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  • Average Individual Mandate Penalty to Rise 47 Percent to $969 in 2016 for Uninsured People Eligible for ACA Plans

    News Release

     3.5 Million Could Have a Zero-Dollar Premium Contribution or Pay Less for Health Insurance than Penalty Due to Premium Subsidies; 7.1 Million Would Pay More to Get Coverage A new analysis from the Kaiser Family Foundation finds that among uninsured people who are eligible for an Affordable Care Act marketplace plan, the average penalty for remaining without coverage in 2016 would be $969 per household – 47 percent higher than the 2015 estimated average of $661.…

  • Bernie Sanders, Hillary Clinton, and Medicare for All

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman explores the differing positions of presidential candidates Hillary Clinton and Bernie Sanders on a single payer or Medicare-for-all health care system and whether Democratic voters consider it an important factor in the 2016 primaries.

  • Bernie Sanders, Hillary Clinton, and Medicare for All

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman explores the differing positions of presidential candidates Hillary Clinton and Bernie Sanders on a single payer or Medicare-for-all health care system and whether Democratic voters consider it an important factor in the 2016 primaries. All previous columns by Drew Altman are online.

  • Will GOP Candidates’ Positions on Obamacare Matter in Crowded Field?

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman analyzes the politics of Republican Affordable Care Act replacement plans and the challenges all Republican candidates will face distinguishing themselves from others on the ACA in a crowded primary field. All previous columns by Drew Altman are available online.

  • Issue Brief Examines the Experiences of Five States During Year Two of Affordable Care Act Coverage Expansions

    News Release

    A new issue brief from the Kaiser Family Foundation draws upon 40 in-person interviews conducted with a variety of stakeholders to assess the recent experiences of five states during the second year of coverage expansions under the Affordable Care Act (ACA).  The interviews took place in three states -- Colorado, Kentucky and Washington -- that have State-based Marketplaces, and have adopted the Medicaid expansion, and in two states -- Utah and Virginia -- that rely…

  • Candidate Policy Plans Resonate More With Democrats. Here’s Why.

    News Release

    As primary election voting approaches, Drew Altman examines whether there is a difference between Democratic and Republican voters when it comes to how much they care about candidates’ policy plans. Read his latest column for The Wall Street Journal’s Think Tank, “Candidate Policy Plans Resonate More With Democrats. Here’s Why.”

  • New Analysis Finds Marketplace Plans with Lowest Premiums Are Often Not the Most Cost-Effective Option for People with HIV

    News Release

    Among 300 Enrollment Options Examined, an HIV Positive Enrollee Could Save $4,000 on Average by Assessing a Fuller Range of Costs A new Kaiser Family Foundation analysis finds that people living with HIV could benefit from looking beyond premium costs when shopping for a health plan in the marketplace – as plans with the lowest premiums are often not the most cost-effective option. People with HIV can find lower cost plans by conducting a more…

  • What New Data Tell Us About Doctor Choice

    News Release

    Is choice of doctors eroding? Drew Altman explores the rhetoric versus reality and why the issue resonates with Americans, in his latest column for The Wall Street Journal's Think Tank. All previous columns by Drew Altman are online.

  • New Analysis Suggests ACA Marketplace Enrollment Could Grow Modestly Over Next Few Years, up to 16.3 Million Sign-Ups, 14.7 Million Enrollees after Attrition

    News Release

    A new analysis from the Kaiser Family Foundation finds that sign-ups in Affordable Care Act marketplace plans could continue to grow modestly over the next few years to 16.3 million (up 28%), based on the experience of the top-performing states. Assessing ACA Marketplace Enrollment examines factors that may have kept enrollment in 2016 from reaching early projections, including smaller declines than expected in employer coverage and a substantial number of people buying their own insurance…