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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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  • Faces of the Medicaid Expansion: Experiences and Profiles of Uninsured Adults Who Could Gain Coverage

    Issue Brief

    These two papers provide insight into how state decisions to expand Medicaid under the Affordable Care Act are likely to impact people. Based on focus groups and interviews conducted in Cincinnati, Houston, Las Vegas and Tampa with uninsured adults who could be eligible for the Medicaid expansion in 2014, these papers highlight the experiences of uninsured adults and the significant health and financial consequences of being uninsured, which sometimes impact their ability to work and…

  • Pulling It Together: Keeping the Health Reform Coalition Together

    Perspective

    We could be headed for a new schism in the debate about health reform. Not the familiar gulf between advocates of the market and government, or the predictable one between deficit hawks and spenders, but a new one that crosses traditional partisan and ideological lines between advocates of long-term reform of the health care delivery system, and immediate help for the uninsured and insured struggling with health care costs.  This new rift is most likely to develop if tight money and a crowded agenda…

  • Pulling it Together: 19.7

    Perspective

    Several years ago Joanne Silberner from NPR offered some advice I liked. Joanne said that the secret to effective communication was to "have a killer anecdote and a killer number." Here is a killer number: 19.7. That's the average number of years between major attempts at health reform since Harry Truman made health reform a top priority and his plan was branded a socialist plot and soundly defeated in 1950. The chart below chronicles the…

  • New Resources & Briefing Examine Medicaid Long-Term Services and Supports

    Event Date:
    Event

    The following resources by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) examine the latest data findings regarding Medicaid’s long-term services and supports for seniors and people with disabilities. The materials were released at a public briefing in the Foundation’s Washington, D.C. offices that featured an expert panel and remarks on long-term services and supports by U.S. Secretary of Health and Human Services Kathleen Sebelius. The reports include: Medicaid Home and Community-Based…

  • How Competitive Are State Health Insurance Markets?

    Issue Brief

    Beginning in 2014, state-based health insurance exchanges will be created to facilitate coverage and choice, with the hope that enhanced competition among insurers will help to moderate premiums for individuals and small groups. This analysis by the Foundation assesses the competitiveness of state insurance markets for individuals and small businesses to establish a baseline as implementation of the health reform law proceeds and to provide context for the policy decisions states will be considering. The…

  • Webcast: New CMS Estimates of State-by-State Health Expenditures

    Event Date:
    Event

    The Kaiser Family Foundation held a live interactive webcast on December 7, 2011, to discuss trends in state health care expenditures and the implications for national and state efforts to constrain health care costs. The webcast examines new state-by-state estimates of public and private health spending from the Centers for Medicare and Medicaid Services (CMS) published in the online journal, Medicare and Medicaid Research Review. An expert panel offers perspectives on the trends within and…

  • How Will Uninsured Childless Adults Be Affected By Health Reform?

    Issue Brief

    This brief examines uninsured childless adults and how they could be affected by health reform, including estimates of how many might qualify for coverage under a Medicaid expansion, how many would be eligible for subsidies and how many would not be eligible for such help. Issue Brief (.pdf)

  • What’s in There? The New Health Reform Law and Private Insurance

    Event Date:
    Event

    This briefing focuses on how the reform law affects access to private coverage, including the new federal high-risk pools, tax credits for small businesses, health insurance exchanges, the individual mandate and employer obligations. This briefing, cosponsored by the Alliance for Health Reform and the Kaiser Family Foundation, explored these and other issues. For more information, please visit Alliance's event page. Full Video    Speakers for this session: The panel is co-moderated by Diane Rowland of…

  • The Health Workforce Dream Team: Who Will Provide the Care?

    Event Date:
    Event

    Many providers and policymakers envision team-based care as an important way to improve quality and maximize resources. The “dream team” includes nurses and many other non-physician providers. But how will we ensure enough health care workers for a growing, aging population with ever-increasing chronic care needs? This December 2 briefing, sponsored by the Alliance for Health Reform and the Robert Wood Johnson Foundation, explored the question, focusing on a new report from the Institute of…

  • Ensuring Access to Care in Medicaid Under Health Reform

    Issue Brief

    This paper examines the key issues raised in a December 2010 roundtable discussion of federal and state officials and experts convened by the Kaiser Commission on Medicaid and the Uninsured to examine important issues related to ensuring access to care in Medicaid under the Patient Protection and Affordable Care Act (ACA). The ACA expands Medicaid to reach millions of low-income uninsured Americans and, recognizing current serious access problems system-wide, takes significant steps to build capacity…