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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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  • Visualizing Health Policy: Preventive Services for Women and the ACA

    Other Post

    This month’s Visualizing Health Policy infographic takes a look at preventive health services for women, including missed opportunities for preventive counseling on risk factors (such as smoking or alcohol) and sexual health issues (such as contraception, sexually transmitted infections, and domestic violence), the effects of lack of insurance on rates of mammograms and other screening tests for women, and how costs are a barrier that cause some women to postpone preventive services or skip a…

  • Medicare Advantage: Take Another Look

    Perspective

    This Policy Insight explores possible explanations for the continued rise in Medicare Advantage enrollment between 2010 and 2013 in spite of a projected decrease following payment changes in the Affordable Care Act (ACA).

  • Those Long Lines To Enroll In The ACA

    News Release

    In the latest post from the series Policy Insights, Kaiser Family Foundation President and CEO Drew Altman discusses the need for community based outreach to enroll the long term uninsured. All previous Policy Insights posts are archived online. The Kaiser Family Foundation, a leader in health policy analysis, health journalism and communication, is dedicated to filling the need for trusted, independent information on the major health issues facing our nation and its people. The Foundation…

  • New Survey Documents Women’s Health Care, Coverage and Early Experiences with the Affordable Care Act

    News Release

    A comprehensive survey released today by the Kaiser Family Foundation provides a snapshot of women and their health coverage and care during a time of transition as important Affordable Care Act insurance market changes began to take root.   These include many changes that affect women including a prohibition on using gender in setting premiums, as well as broadening access to a more comprehensive range of preventive services benefits without cost sharing. The Kaiser Women’s Health…

  • Getting into Gear for 2014: Insights from Three States Leading the Way in Preparing for Outreach and Enrollment in the Affordable Care Act

    Issue Brief

    This report provides insight into preparations in Maryland, Nevada, and Oregon -three states that have established a State-based Marketplace, are moving forward with the Medicaid expansion, and are among the states leading the way in preparing for outreach and enrollment. e findings provide an overview of where these three states are in establishing their Marketplaces; preparing for the Medicaid expansion; planning for marketing, outreach and enrollment; and establishing enrollment assistance resources. It highlights the challenges…

  • Visualizing Health Policy: Premium Subsidy Scenarios Under Obamacare

    Other Post

    This month’s Visualizing Health Policy infographic shows 3 scenarios that illustrate the cost of health insurance under the Affordable Care Act for families in different circumstances, both before and after premium subsidies (in the form of a tax credit).

  • Helping Hands: A Look at State Consumer Assistance Programs under the Affordable Care Act

    Issue Brief

    Navigator and In-Person Assister programs created by the Affordable Care Act (ACA) will provide outreach and enrollment assistance during the open enrollment period for the new health insurance Marketplaces. This brief describes these programs, highlighting differences in how they are funded and structured and discusses some of the challenges they face.

  • How Obamacare May Be Holding Down Costs

    From Drew Altman

    In his latest column published in Politico, Kaiser President and CEO Drew Altman examines the recent historic slowdown in health-care costs and discusses whether Obamacare is a contributing factor.

  • No Quick Verdict on Obamacare

    From Drew Altman

    This column originally appeared in Politico on September 30. Dr. Altman's future Politico columns will be posted on kff.org one day after publication. October 1, the focus of great attention in the Obamacare wars, is finally here. Today is the day open enrollment begins for the new health insurance marketplaces, where Americans can log on and sign up for coverage. The media, opponents, and proponents have been gearing up for a big day — or,…