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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  • Enrollment Surge Did Not Change Public’s Views on the Affordable Care Act

    News Release

    Most Common Reason for Remaining Uninsured is Not Being Able to Find an Affordable Plan; Just 7 Percent Would Rather Pay a Fine than Pay for Coverage As the Supreme Court Considers Challenge, a Majority Supports the Law's Requirements for Contraceptive Coverage, Including for Employers with Religious Objections Despite the news that 8 million people have signed up for health insurance through the ACA’s new marketplace, the April Kaiser Health Tracking Poll finds no change…

  • 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).

  • The Health-Cost Problem Is Coming Back

    From Drew Altman

    Drew Altman, in The Wall Street Journal’s Think Tank, discusses how the conversation will soon shift back to health-care costs from health coverage, because they are rising more sharply again. And as the discussion turns back, he says that because there is no national agreement on a strategy to address increasing costs, current efforts in the public and private sector, however fragmented and uncoordinated, will need to step up their game.

  • An Overview of Medicaid Incentives for the Prevention of Chronic Diseases (MIPCD) Grants

    Issue Brief

    This brief provides an overview of the Medicaid Incentives for the Prevention of Chronic Diseases (MIPCD) grants and highlights key findings from the interim evaluation of the program. The brief also places these grants in context of pre-Affordable Care Act (ACA) Medicaid beneficiary incentive programs and proposed programs of states that are incorporating healthy behavior incentives into Medicaid expansion waivers.

  • Connecting Consumers to Coverage: Lessons Learned from Assisters for Successful Outreach and Enrollment

    Issue Brief

    This brief highlights the experiences of Navigators and other Marketplace consumer assistance programs under the Affordable Care Act (Obamacare) in conducting outreach and providing enrollment assistance during the ACA's first open enrollment period. It provides insight into the outreach and enrollment strategies the assisters developed and identifies the keys to successfully overcoming the challenges of the first year. These insights are based on findings from focus groups with assisters in four cities: Miami, Florida; Houston,…

  • Report Provides Insights from Consumer Assisters on Improving Affordable Care Act’s Next Open Enrollment

    News Release

    A new report from the Kaiser Family Foundation and Robert Wood Johnson Foundation captures insights from those who helped consumers navigate the Affordable Care Act's first open enrollment period, including lessons for the second , which is set to start Nov. 15. “Taking Stock and Taking Steps: A Report from the Field after the First Year of Marketplace Consumer Assistance Under the ACA” draws on the experiences of 80 program leaders who participated in a…

  • Nine in Ten Uninsured Unaware that the Affordable Care Act’s Second Open Enrollment Period Starts in November

    News Release

    Most of Those Without Health Coverage Report Knowing Little or Nothing About the Insurance Marketplaces or About the Financial Assistance Available to Low- and Moderate-Income Families Broader Public Opinion on the Law Still Tilts Unfavorably, Though Gap Has Narrowed Since July and Returned to Pre-Rollout Levels With the second annual open enrollment period under the Affordable Care Act set to begin Nov. 15, the latest Kaiser Family Foundation tracking poll finds major gaps in the…

  • Healthy Indiana Plan and the Affordable Care Act

    Fact Sheet

    This fact sheet provides an overview of the Healthy Indiana Plan, Indiana's 1115 waiver demonstration project, and how it relates to the Affordable Care Act's Medicaid expansion.

  • A Guide to the Supreme Court’s Review of the Contraceptive Coverage Requirement

    Issue Brief

    This issue brief dissects the issues raised by the legal challenges to the Affordable Care Act’s requirement that private insurance plans include contraception as part of their coverage of preventive services for women. Over 40 for-profit corporations and over 40 nonprofit corporations have filed lawsuits claiming that the requirement to provide their employees with contraceptives violates their religious rights. On November 26, 2013, the Supreme Court agreed to hear two cases filed by for-profit corporations,…

  • How Will the Uninsured in Alaska Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Alaska, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Alaska are eligible for Medicaid or financial assistance in…