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Affordable Care Act

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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  • Pulling it Together: Health Reform’s Six-Month Checkup

    Perspective

    Six months after its enactment, there are two totally different stories to tell about the health-reform law. The public remains split on the law largely along traditional partisan lines. Confusion and misperception are rampant, with more than a third of seniors still thinking the law contains "death panels" (it does not). Yet beneath the political battle lies a success story of early implementation: The federal government that many regard as sluggish and ineffective has turned…

  • 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…

  • Poll: Democrats Like Both the Public Option and Medicare-for-all, But Overall More People Support the Public Option, Including a Significant Share of Republicans

    News Release

    Lowering Drug Costs and Maintaining Pre-existing Condition Protections Top Public’s Health Priorities for Congress With the first votes of the 2020 Democratic presidential primary season approaching, large majorities of Democrats – and most of the public overall – support both of the major approaches primary candidates have put forward to expand coverage and make health care more affordable, though a public option remains significantly more popular than Medicare-for-all, the latest KFF Health Tracking Poll finds.…

  • Analysis: Marketplace Plans Denied an Average of Nearly One in Five Claims in 2017 with Wide Variations across Insurers

    News Release

    Healthcare.gov marketplace insurers denied nearly one out of every five claims (19%) submitted for in-network services in 2017, and enrollees only appeal a tiny share (0.5%) of those denied claims, a KFF analysis of recently released claims data finds. The analysis finds a huge variation across insurers, with average denial rates as low as 1 percent and as high as 45 percent. Denial rates also vary across states, though individual insurers in the same state…

  • Two Medicaid-Related Initiatives That Help Promote Long-Term Care at Home and in the Community, Rather Than in Institutions, Are Set To Expire at the End of December

    News Release

    Two initiatives that for years have helped shift Medicaid enrollees away from nursing homes in favor of long-term care at home and in the community face year-end deadlines that could undercut that trend, according to two new KFF issue briefs. While there does not appear to be substantive disagreement over the initiatives like there is with many other federal health programs, their expiration is coming at a time when Congress is engaged in a contentious…

  • Private Insurance’s Costs are Skyrocketing

    From Drew Altman

    In this Axios column, Drew Altman takes a long-term view of the recently released federal data on health spending showing that spending for private insurance is rising much faster than for Medicare and Medicaid, and predicts rising pressure in the health care industry as a result. 

  • Health Policy in 2020 Will Be Made in the States

    From Drew Altman

    With a questionable outlook for 2020 passage of legislation on prescription drug pricing and surprise medical bills, Drew Altman says the real action to watch in health policy is likely to be in the states.

  • 2018 Elections: Key Medicaid Issues to Watch

    Issue Brief

    Medicaid provides health insurance coverage for more than 76 million Americans, supplies funding for safety-net providers, and is the largest source of federal revenues for states. At this time last year, Congress was debating repeal and replace of the Affordable Care Act (ACA) as well as more fundamental changes to Medicaid financing. While federal legislative changes to Medicaid did not pass in 2017, the outcomes of the 2018 elections will shape program changes at both…

  • Poll: Most Democrats Prefer a Presidential Candidate Who Wants to Build on the Affordable Care Act

    News Release

    The latest KFF Health Tracking Poll probes Democrats’ views about the general approaches to expanding health coverage and lowering costs put forward by the candidates. Most Democrats and Democratic-leaning independents (55%) say they prefer a candidate who would build on the Affordable Care Act to achieve those goals. Fewer (40%) prefer a candidate who would replace the ACA with a Medicare-for-all plan. Even among those who prefer a candidate who would replace the ACA with…