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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.

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

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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  • The Ryan White Program and Insurance Purchasing in the ACA Era: An Early Look at Five States

    Issue Brief

    This issue brief examines the role that the Ryan White Program has played in helping HIV positive clients purchase insurance coverage from both a historical and an Affordable Care Act (ACA) era perspective. The ACA era analysis focuses on activities in five states during the first open enrollment period and looks specifically at insurance purchasing through the health insurance marketplaces. The states analyzed are California, Florida, Georgia, New York, and Texas.

  • Repayments and Refunds: Estimating the Effects of 2014 Premium Tax Credit Reconciliation

    Issue Brief

    This analysis estimates the range of repayment or refund amounts of the advanced premium tax credits issued to enrollees who experience income volatility between the time of enrollment and tax credit reconciliation. Using a simulation model among all households eligible for advance payments of the premium tax credits under the Affordable Care Act, it estimates that half would owe a repayment while 45 percent would be issued a refund of some or all of premium…

  • New Analysis: Half of U.S. Households Eligible for a Tax Subsidy Under the Health Law Would Owe a Repayment, While 45 Percent Would Receive a Refund

    News Release

    Estimated Average Repayment is $794. Estimated Average Refund is $773. Half of U.S. households eligible for a 2014 tax subsidy under the Affordable Care Act would owe a repayment to the government, while 45 percent would receive a refund, according to estimates from a new analysis by the Kaiser Family Foundation. The analysis – which is a simulation based on historical patterns of income volatility among all households eligible for ACA premium subsidies -- estimates that the…

  • Measles Outbreak and Vaccination Debate Capture Public’s Attention

    News Release

    Those Following Measles Story More Likely To Say They Worry About the DiseaseThe public paid more attention to news coverage of the measles outbreak in the U.S. and the resulting debate on whether vaccinations should be required for all kids than any other news story included in this month's Kaiser Health Policy News Index. A total of 70 percent of Americans say they closely followed the measles story, more than say the same about the…

  • Kaiser Health Policy News Index: March 2015

    Feature

    The public paid more attention to news coverage of the measles outbreak in the U.S. and the resulting debate on whether vaccinations should be required for all kids than any other news story included in this month's Kaiser Health Policy News Index. Nearly half correctly identified that the number of confirmed measles cases in the U.S. since the outbreak began late last year is closer to 100, and most say they are not too or…

  • At Five Year Anniversary of the ACA, Gap Between Favorable and Unfavorable Views Among The Public Narrows to Smallest Spread in More Than Two Years

    News Release

    Most Expect Negative Consequences if Supreme Court Prohibits Subsidies in States Without Their Own Insurance Exchanges; Two Thirds of the Public and Those in Affected States Want Congress or Their State to Close Any Gaps As April 15 Tax Deadline Nears, Nearly Half Unaware Insurance Reporting Requirement Starts This Year Five years after President Obama signed the Affordable Care Act, this month's Kaiser Health Tracking Poll finds the closest split between favorable and unfavorable views…

  • Kaiser Health Tracking Poll: March 2015

    Feature

    As the Affordable Care Act (ACA) marks its fifth anniversary, this month’s poll finds the gap between favorable and unfavorable opinions of the law has narrowed to the closest margin in over two years. Although the Supreme Court heard oral arguments for the King v. Burwell case in early March, the majority of the public continues to say they have heard only a little or nothing at all about the case. The survey also includes…

  • Community Health Centers: A 2013 Profile and Prospects as ACA Implementation Proceeds

    Issue Brief

    Community health centers are an integral part of the health care safety-net, providing access to care for nearly 22 million people in underserved communities. The ACA established trust fund for health center growth, and with increased patient revenues attributable to expanded coverage, health centers’ grant funding to support care of the uninsured can go further. This brief provides a 2013 data profile of health centers; highlights pre-ACA differences between health centers in Medicaid expansion and…

  • JAMA Forum: Of SCOTUS and Chicken

    Perspective

    Larry Levitt's March 2015 post explores what could happen if the U.S. Supreme Court rules for the plaintiffs in the King v. Burwell case, the lawsuit that challenges the federal government’s authority to provide financial assistance to people who buy insurance in federally-operated marketplaces created by the Affordable Care Act.