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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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  • Brief Provides Update on LGBT Coverage and Health as More States Recognize Same-Sex Marriage

    News Release

    An updated issue brief from the Kaiser Family Foundation gives a detailed profile of health concerns for lesbian, gay, bisexual and transgender individuals, offers the latest demographic data, and discusses the impact of recent changes in state and federal policies on health coverage, including the Affordable Care Act and same-sex marriage. As of this month, same-sex marriage is recognized in 32 states and the District of Columbia. The brief, Health and Access to Care and…

  • An Update on Coverage for Preventive Services Under the Affordable Care Act

    News Release

    An updated fact sheet from the Kaiser Family Foundation summarizes the latest information on health plan coverage of preventive services under the Affordable Care Act. The fact sheet details the rules that govern when plans are required to cover services without cost-sharing and which services are covered. In addition, the fact sheet summarizes the clarifications issued by the U.S. Department of Health and Human Services on coverage for a number of services including: colon cancer…

  • JAMA Forum: Why Health Insurance Literacy Matters

    Perspective

    Larry Levitt's November 2014 post looks at the challenges with people not understanding basic health insurance concepts as millions of them evaluate and choose health plans during open enrollment season for insurance in 2015.

  • El seguro de salud, explicado: ¡los YouToons lo tienen cubierto!

    Video

    El seguro de salud, explicado: ¡los YouToons lo tienen cubierto! desglosa conceptos de seguros como primas, deducibles y redes de proveedores.  Explica cómo las personas pagan por su cobertura y cómo obtener cuidado médico y medicamentos recetados con distintos tipos de seguros de salud, incluyendo HMOs y PPOs.

  • Primers on Key Health Care Topics and Programs

    Issue Brief

    The Kaiser Family Foundation maintains a number of primers providing overviews of key health care programs and issues. Written by Foundation staff, each primer provides key data and information that helps illustrate the topic and its relevance for the nation's health care system. Medicaid: A Primer Medicare: A Primer The Uninsured: A Primer Health Care Costs: A Primer How Private Health Coverage Works: A Primer Mental Health Financing in the United States: A Primer The…

  • Pulling It Together: The Falloff in Utilization: “There’s Something Happening, Here, What It Is Ain’t Exactly Clear”

    Perspective

    For as long as I have been in the field, we have seen cycles in health care costs. Per capita health spending would rise, then moderate, then rise gain. My colleague Larry Levitt and I documented this in The Sad History of Health Care Costs and my friend Dr. Jim Mongan called it “the peaks and valleys” of health care costs. We have never been sure whether the "valleys" were the result of government actions, such…

  • Eliminating Racial/Ethnic Disparities in Health Care: What are the Options?

    Issue Brief

     Download PDF Racial and ethnic disparities in health care – whether in insurance coverage, access, or quality of care – are one of many factors producing inequalities in health status in the United States.1  Eliminating these disparities is politically sensitive and challenging in part because their causes are intertwined with a contentious history of race relations in America. Nonetheless, assuring greater equity and accountability of the health care system is important to a growing constituency…

  • Five Key Questions And Answers About Section 1115 Medicaid Waivers

    Issue Brief

    This issue brief provides an overview of what Section 1115 Medicaid waivers are, how they are approved and financed, how states have used them, and how they are impacted by health reform. For many years, Section 1115 waivers have been used by states to test new coverage approaches not otherwise allowed under Medicaid program rules. Some waivers have also raised important policy issues. Since the passage of the health reform law, several states, including California,…

  • Poll Finds Bipartisan Public Support For Creating State Insurance Exchanges Despite Continuing Party Divisions Over the ACA

    News Release

    More Americans Back Than Oppose State Medicaid Expansions But, Like Many Governors, Public Splits Along Party Lines On The Federal Deficit, Public Wants Action But Still Resists Most Cuts and Sacrifices, Especially to Medicare A majority of Americans put the creation of state-based health insurance exchanges at the top of the priority list for health policy in their state this year, according to a survey released today by the Kaiser Family Foundation, the Robert Wood…

  • 2016 Survey of Health Insurance Marketplace Assister Programs and Brokers

    Report

    In its third year, the survey tracks the experiences of assistance programs signing people up for Affordable Care Act coverage during open enrollment and, for consumers who qualify, during special enrollment periods. This year, for the second time, the survey includes health insurance brokers who helped people apply for non-group coverage in an ACA marketplace.