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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

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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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  • The Republican Health-care Plan the Country Isn’t Debating

    From Drew Altman

    In this Washington Post op-ed, Drew Altman discusses how Republicans' ideas to change Medicaid and Medicare and repeal the Affordable Care Act would fundamentally change the federal role in health, calling it: the biggest change in health we are NOT debating.

  • Key Issues in Children’s Health Coverage

    Issue Brief

    This brief reviews children’s coverage today and examines what is at stake for children’s coverage in upcoming debates around CHIP funding, repeal and replacement of the ACA, and Medicaid restructuring.

  • Compare Key Elements of ACA Repeal and Replace Proposals with New Interactive Tool

    News Release

    President Trump and Republicans in Congress have committed to repealing and replacing the Affordable Care Act. A new interactive tool from the Kaiser Family Foundation enables users to create side-by-side comparisons of major ACA alternative plans, now including 2017 proposals from Sen. Rand Paul and from Sen. Bill Cassidy. With the tool, users can compare the plans’ approaches to more than a dozen key areas of health policy, including individual insurance market rules, requirements and…

  • In Focus: Listening to Enrollees with Affordable Care Act Coverage Who Voted for Trump

    News Release

    As Republicans in Washington pursue efforts to repeal and replace the Affordable Care Act, what do enrollees in ACA marketplaces and state Medicaid expansions who voted for President Trump want in a health care plan? The Kaiser Family Foundation asked some of them in six focus groups convened in December in Michigan, Ohio, and Pennsylvania -- three with Trump voters enrolled in the ACA marketplaces and three with Trump voters in Medicaid. Focus group participants…

  • Where President-elect Donald Trump Stands on Six Health Care Issues

    Issue Brief

    Where does President-elect Donald Trump stand on key health care issues? This snapshot outlines his positions and policy statements during the campaign on issues such as health insurance, the ACA, Medicaid, Medicare, the opioid epidemic, prescription drug costs, and women's reproductive health.

  • The American Health Care Act: New House GOP Bill Summary and Interactive Maps of Its Effects on Tax Credits

    News Release

    The Kaiser Family Foundation today issued a summary of the Republican House leadership’s March 6 proposed Affordable Care Act (ACA) replacement bill, the American Health Care Act, that can be compared in 17 key policy areas to the ACA and several other proposed replacement plans. In addition, the Foundation updated its interactive maps that compare county-level estimates of premium tax credits consumers would receive under the Affordable Care Act (ACA) in 2020 with what they’d receive…

  • Web Briefing for Journalists – Potential Changes to Health Care Access and Coverage: What’s at Stake for Women?

    Event Date:
    Event

    House Republicans’ American Health Care Act and other actions under discussion by President Donald Trump’s administration and the new Congress could profoundly affect access to health care for many women. Repeal of the Affordable Care Act, changes to its birth control coverage provision, and new state and federal abortion restrictions, along with potential funding cuts and restrictions for family planning providers, including Planned Parenthood, would significantly impact the availability and cost of women’s health care,…

  • Who Are the 7 Million Nonelderly Adults with Disabilities in Medicaid and What Would the House GOP Bill to Restructure Medicaid Financing and Repeal the Affordable Care Act Mean for Them?

    News Release

    A new brief from the Kaiser Family Foundation explains the role that Medicaid plays for nearly 7 million nonelderly adults with disabilities in the U.S. and explores what the American Health Care Act could mean for their health care and coverage. Medicaid covers more than three in 10 nonelderly adults with disabilities, including people with physical disabilities, such as cerebral palsy, multiple sclerosis, and traumatic brain or spinal cord injuries; intellectual or developmental disabilities such…

  • Data Note: What if Per Enrollee Medicaid Spending Growth Had Been Limited to CPI-M from 2001-2011?

    Issue Brief

    Congress is currently debating the American Health Care Act (AHCA), which would repeal and replace the Affordable Care Act (ACA) and also make substantial changes to the structure and financing of Medicaid. Among other provisions, the AHCA would use a per capita cap policy to cap federal funds to states for Medicaid. This data note examines what the implications of tying per enrollee growth to CPI-M would have been for the 2001-2011 period for federal…