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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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  • Most Say They Can Afford Their Prescription Drugs, But One in Four Say Paying is Difficult, Including More Than Four in Ten People Who are Sick

    News Release

    Large Bipartisan Majorities Support Range of Policy Changes They Believe Would Curb Drug Costs Opinion on the Affordable Care Act Remains Largely Unchanged In August About half of Americans (54%) report currently taking a prescription drug, and a large majority of them (72%) say their prescriptions are very or somewhat easy to afford. However, about a quarter (24%) say paying for their drugs is difficult, and the share facing difficulties rises among those with low…

  • The California Health Care Landscape

    Fact Sheet

    This fact sheet provides an overview of population health, health coverage, and the health care delivery system in California in the era of health reform.

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

    From Drew Altman

    In this 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.

  • New Tracker Monitors Affordable Care Act Preventive Services Coverage

    News Release

    The Affordable Care Act requires private insurance plans to cover recommended preventive services with no out-of-pocket charges for patients. This slate of covered services can change when the U.S. Preventive Services Task Force and other authorized groups add or modify recommendations; the federal government also periodically issues clarifications to guide health plans in their coverage. A new tracker from the Kaiser Family Foundation monitors the preventive services that must be covered for adults without cost sharing,…

  • People in ACA Marketplaces Who Say They Benefited or Were Negatively Affected By ACA

    Feature

    People in ACA Marketplaces Who Say They Benefited or Were Negatively Affected By ACA Download Source Analysis of Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees, Wave 3 (Feb. 9-Mar. 31, 2016) Related: Column/Op-Ed: Partisanship’s Grip On The Affordable Care Act Survey of Non-Group Health Insurance Enrollees Early Release Methodology

  • ACA Coverage Expansions and Low-Income Workers

    Issue Brief

    This brief highlights low-income workers and the impact of ACA coverage expansions on this population. Low-income workers may not have access to jobs that provide full-time, full-year employment or jobs with comprehensive benefit packages, including health insurance. Medicaid plays an important role in providing health coverage for low-income workers, and coverage expansions implemented under the ACA have produced substantial coverage gains for low-income workers and a corresponding reduction in the uninsured. However, low-income workers in…

  • The Next Big Debate in Health Care

    From Drew Altman

    In this Wall Street Journal Think Tank column, Drew Altman discusses why adequacy of health coverage will rise as an issue when the political world moves on from its focus on the Affordable Care Act.

  • Two Substantive Sides to Debate Over Obamacare’s ‘Cadillac Tax’

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman says the debate about whether to keep or repeal the Cadillac tax is more than a debate between sound policy and good politics, there are strong substantive arguments on both sides. All previous columns by Drew Altman are available 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.