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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

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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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  • Medicare for All is a Double-Edged Sword for Democrats

    From Drew Altman

    In an Axios column, Drew Altman analyzes the political pros and cons of Medicare for All and Medicare buy-in plans for Democrats, and how they may handle it in Congress and the presidential campaign.

  • New Rules for Section 1332 Waivers: Changes and Implications

    Issue Brief

    On October 22, 2018, the Trump administration released new guidance on Section 1332 waivers established by the Affordable Care Act (ACA). The new guidance may encourage states to use 1332 waiver authority to make broader changes to insurance coverage for their residents, including to promote the sale of, and apply subsidies to, ACA non-compliant policies. On November 29, 2018, the Centers for Medicare and Medicaid Services (CMS) released a discussion paper outlining a set of…

  • Un año después de las tormentas: la recuperación y la atención de salud en Puerto Rico y las Islas Vírgenes de EE.UU. (Informe)

    Issue Brief

    Un año después que los huracanes Irma y María tocaran tierra, Puerto Rico y las Islas Vírgenes de EE.UU. (USVI) todavía sienten los efectos de las tormentas. Basándose en entrevistas con partes interesadas clave y en informes públicos, este reporte proporciona una visión general del estado de recuperación y los esfuerzos de preparación para la actual temporada de huracanes, un año después de las tormentas, enfocándose en los sistemas de atención de salud de los…

  • Public Opinion on Single-Payer, National Health Plans, and Expanding Access to Medicare Coverage

    Feature

    PublicOpinionSinglePayerKFF Download For many years, Kaiser Family Foundation has been tracking public opinion on the idea of a national health plan (including language referring to Medicare-for-all since 2017). Historically, our polls have shown support for the federal government doing more to help provide health insurance for more Americans, though support among Republicans has decreased over time (Figure 1). But this never translated into majority support for a national health plan in which all Americans would…

  • Poll: As Midterms Approach, Health Care Remains Voters’ Top Issue, But President Trump and Other Factors Also Loom Large

    News Release

    Most Florida Voters Favor Expanding Medicaid in their State, As Do Voters across All Non-Expansion States In an expansive look at the role issues and politics may play in the 2018 midterm elections, the latest KFF Health Tracking Poll continues to find health care as the top issue for voters, but large shares of voters also say candidate characteristics, President Trump, and party control over Congress will be major factors. In the last KFF tracking…

  • Conversation on Health Care and the 2018 Midterm Elections

    Event Date:
    Event

    Health care ranks among the top issues voters want to hear candidates talk about on the campaign trail, with costs being the most concerning health issue for voters. Meanwhile, the constitutionality of the Affordable Care Act (ACA) continues to be challenged in the judicial system with the latest case potentially jeopardizing the law’s protections for people with pre-existing conditions. And in four states, ACA Medicaid expansion initiatives are on the ballot to newly expand or…

  • Compare Medicare-for-all and Public Plan Proposals

    Interactive

    This side-by-side interactive compares 10 bills to expand public health coverage through Medicare-for-All, a public option and other approaches, that have been introduced in the current Congress. The interactive allows users to compare these proposals across a number of dimensions, including eligibility, benefits, cost sharing, provider payments, and more.

  • How Pending Health-Related Lawsuits Could be Impacted by the Incoming Trump Administration

    Issue Brief

    This brief provides an overview of current lawsuits in health policy including preventive services, abortion care, gender affirming care, Medicare drug price negotiations, nursing home staffing rules, private coverage consumer protections, and protections and health coverage for Deferred Action for Childhood Arrivals (DACA) recipients; how they may be affected by the incoming Trump administration; and the implications of their potential outcomes.