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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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  • Preventive Services Covered by Private Health Plans under the Affordable Care Act

    Fact Sheet

    Note:  This content was updated on February 28, 2024  to incorporate new FAQs from CMS. Tables 1 and 2 were also updated to include updated recommendations. It has been more than ten years since the Affordable Care Act (ACA) required private insurance plans to cover recommended preventive services without any patient cost-sharing. Research has shown that evidence-based preventive services can save lives and improve health by identifying illnesses earlier, managing them more effectively, and treating…

  • Average Annual Premiums for Family Health Benefits Top $15,000 in 2011, Up 9 Percent, Substantially More than the Growth in Worker’s Wages, Benchmark Employer Survey Finds

    News Release

    NEWS RELEASESeptember 27, 2011 Average Annual Premiums for Family Health Benefits Top $15,000 in 2011, Up 9 Percent, Substantially More than the Growth in Worker’s Wages, Benchmark Employer Survey FindsAbout 2.3 Million Young Adults Added to Parents’ Plan As a Result of Health Reform At Small Firms, One in Four Covered Workers Face Annual Deductible of $2,000 or More MENLO PARK, Calif. -- After several years of relatively modest premium increases, annual premiums for employer-sponsored…

  • Medicaid Coverage and Care for the Homeless Population: Key Lessons to Consider for the 2014 Medicaid Expansion

    Report

    Beginning in 2014, the Affordable Care Act ACA provides for a significant Medicaid expansion uninsured, low-income adults. Given their low incomes and high uninsured rate, individuals experiencing homelessness could significantly benefit from this expansion. However, it will be important to address the barriers they face to enrolling in coverage and accessing needed care. This report, based on eight focus group discussions with administrators and frontline workers serving the homeless population in four cities, identifies enrollment…

  • Medicare Savings in Perspective: A Comparison of 2009 Health Reform Legislation and Other Laws in the Last 15 Years

    Issue Brief

    Although Medicare is not the main focus of current health reform legislation, the bill recently passed by the House—H.R. 3962, America’s Affordable Health Choices Act of 2009—and the bill before the Senate—H.R. 3590, Patient Protection and Affordable Care Act—include a number of provisions that would affect Medicare program expenditures. This policy brief considers the proposed 10-year Medicare savings and increased spending in the two proposals in the context of other laws enacted during the last…

  • Massachusetts Health Care Reform: Six Years Later

    Issue Brief

    In 2006, then-Gov. Mitt Romney signed Massachusetts' comprehensive health reform designed to provide near-universal health insurance coverage for state residents. Building on a long history of health reform efforts, the state embarked on an ambitious plan to promote shared individual, employer, and government responsibility. This brief examines Massachusetts' experience with coverage and access to care over the last six years, as well as the state's ongoing efforts to deal with persistent high health-care costs. The…

  • Approaches to Covering the Uninsured: A Guide

    Issue Brief

    The guide explains the key strategies for expanding coverage to the nation's 45 million uninsured people and explains and how different policy options can be combined to form comprehensive reform proposals. It organizes the various policy strategies under four overall approaches: strengthening current coverage arrangements, improving the affordability of coverage, improving the availability of coverage and changing the tax treatment and financing of health insurance. Guide (.pdf)

  • Pulling it Together: This Could Be the Next Big Issue in Health Reform

    Perspective

    No, this is not about “death panels.” The town hall meetings.  The media coverage of the town hall meetings.  Media polls about how the American people feel about the town hall meetings.  And even the media myth busting and fact checking about the most extreme claims made at the town hall meetings and the Administration's daily efforts to set the record straight.  All these things have focused attention on a few hot button issues that…

  • Getting Connected: Can the ACA Improve Access to Health Care in Rural Communities?

    Event Date:
    Event

    Residents of rural communities face unique health care challenges, including fewer health care providers, higher rates of chronic disease, and lower adoption rates of health information technology. This October 13 briefing, cosponsored by the Alliance for Health Reform and the United Health Foundation, looked at the many provisions in the Patient Protection and Affordable Care Act (ACA) that speak to the needs of rural communities, with a focus on boosting the health care workforce and…

  • Coordinating Coverage and Care in Medicaid and Health Insurance Exchanges

    Issue Brief

    The Kaiser Commission on Medicaid and the Uninsured convened a roundtable discussion on August 31, 2010 with a group of national and state experts to discuss key issues related to coordinating coverage and care in Medicaid and the new Health Insurance Exchanges under health reform. The Patient Protection and Affordable Care Act requires states to create a coordinated, simple and technologically-supported process through which individuals may obtain Medicaid, Children’s Health Insurance Program and subsidized Exchange…

  • Medicaid Enrollment Under the Affordable Care Act: Understanding the Numbers

    Issue Brief

    This issue brief walks through data recently released from Health and Human Services (HHS) and what it can and cannot tell us about the number of people that have applied for Medicaid since open enrollment for health insurance marketplaces began, how many have enrolled, and what the role of the ACA is in recent Medicaid coverage gains.