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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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  • Majority Favors the Affordable Care Act’s Employer Mandate, But Opinion Can Shift When Presented With Pros and Cons

    News Release

    Recent news stories on the heath law did not attract most Americans’ attention, and many are unaware of details and implications of the developments Weeks before the Affordable Care Act’s employer mandate takes effect in January, a new Kaiser Family Foundation tracking poll finds that six in 10 Americans (60%) say they have a favorable view of the provision, which in 2015 requires employers with 100 or more full time workers to offer health coverage…

  • Web Briefing: Modern Era Medicaid and CHIP – Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies

    Event Date:
    Event

    The Kaiser Commission on Medicaid and the Uninsured (KCMU) hosts a web briefing to present findings from our 13th annual 50-state survey of Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies. The survey provides a profile of where states stand as of January 2015, one year into the implementation of the major Medicaid provisions of the Affordable Care Act (ACA).

  • Harvard and Growth in Health Care Cost Sharing

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman explains why recent discussion of Harvard University’s introduction of new health insurance cost sharing measures amounted to “making a mountain out of a mole hill”.

  • A Perilous Gap in Health Insurance Literacy

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses how progress in expanding coverage requires greater attention to the problem of health insurance literacy.

  • A Perilous Gap In Health Insurance Literacy

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, A Perilous Gap In Health Insurance Literacy, Drew Altman discusses how progress in expanding coverage requires greater attention to the problem of health insurance literacy. All previous columns by Drew Altman are available online.

  • In Employer Health Insurance Costs, Stability Is the New Normal

    From Drew Altman

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman looks at the sharply slower growth in premiums for employer health benefits and what it might mean for the future of employer-sponsored coverage.

  • Web Briefing for Journalists: Consumer Issues Ahead of the Affordable Care Act’s Second Open Enrollment Season

    Event Date:
    Event

    The Affordable Care Act's second annual open enrollment period starts Nov. 15 and runs until Feb. 15 -- a three-month window for Americans to shop for and purchase new health coverage, or change their plan through Healthcare.gov or their state-run insurance marketplace.  This year's open enrollment season poses both new and recurring challenges for consumers:  How are premiums for marketplace plans changing, and what do the changes mean for consumers?  Why might current marketplace customers…

  • The ACA’s Basic Health Program Option: Federal Requirements and State Trade-Offs

    Report

    The Patient Protection and Affordable Care Act (ACA) gives states the option to implement a Basic Health Program (BHP) that covers low-income residents through state-contracting plans outside the health insurance marketplace, rather than qualified health plans (QHPs). In March 2014, the Centers for Medicare & Medicaid Services (CMS) issued final regulations on the requirements for a BHP and the methodology for calculating federal payments to states. States can choose to implement BHP beginning in 2015.…