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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  • Health Coverage for the Black Population Today and Under the Affordable Care Act

    Fact Sheet

    The Affordable Care Act (ACA) could help many uninsured Blacks through the law’s expansion of Medicaid and the creation of new health insurance exchange marketplaces with tax credits to help moderate-income people purchase coverage. This brief provides an overview of the Black population in the U.S., their health coverage today and the potential impact of the ACA coverage expansions.

  • Children’s Health Coverage: Medicaid, CHIP and the ACA

    Issue Brief

    This brief provides an overview of children’s coverage leading up to the implementation of the Affordable Care Act (ACA), a review of changes for children included in the ACA, and a look at issues leading up to the reauthorization of the CHIP program.

  • Health Reform: How Will Medicaid Change? Tutorial

    Interactive

    This tutorial was produced for kaiserEDU.org, a Kaiser Family Foundation website that ceased production in September 2013. The kaiserEDU.org tutorials are no longer being updated but have been made available on kff.org due to demand by professors who are using the tutorials in class assignments. You may search for other tutorials to view on kff.org. To download this or other tutorials, visit the tutorials archive page.  Slides are available for download using the "Download Slides" link within the…

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

    Fact Sheet

    This report explains how the ACA expands coverage nationally, 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 are eligible for Medicaid or financial assistance in the Marketplace. For states…

  • How Obamacare Is Doing Better But Feeling Worse  

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman explains why even as there are recent positive indicators of the Affordable Care Act’s performance and impact, public opinion about the law has not changed since passage of the law. All previous columns by Drew Altman are available online.

  • Women's Health Coverage promo

    How Does Where You Work Affect Your Contraceptive Coverage?

    Interactive

    The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for a broad range of preventive services including FDA approved prescription contraceptives and services for women. Legal challenges and recently issued rules have affected contraceptive coverage for many women.

  • Premiums Set to Decline Slightly for Benchmark ACA Marketplace Insurance Plans in 2015

    News Release

    Analysis of 15 States and D.C. Also Finds Changes Vary Across States and Insurers Results Suggest Consumers Should Shop Carefully When Open Enrollment Begins November 15 MENLO PARK, Calif. -- An early look at the cost of health insurance in 16 major cities finds that average premiums for the benchmark silver plan – the one upon which federal financial help under the Affordable Care Act to consumers is based – will decrease slightly in 2015. …

  • Republicans Have an Edge in Voter Enthusiasm Heading Into Fall, But Few Cite ACA as Motivating Factor

    News Release

    Anti-Obamacare Ads Reaching Most Voters in Competitive Senate Races Health Care Ranks Among Several Second-Tier Issues for Voters in Midterm Elections Behind the Economy The latest Kaiser Family Foundation Health Tracking Poll finds Republicans with a modest edge in terms of voter enthusiasm, but the Affordable Care Act, also called Obamacare, is not the main motivator. The poll finds that 27 percent of Republicans say they are “more enthusiastic” about voting this year than in…

  • Abortion Coverage in Marketplace Plans, 2015

    Issue Brief

    This brief analyzes state policies and insurer coverage decisions affecting the availability of abortion coverage in 2015 insurance plans offered through the Marketplaces. It finds that abortion coverage is unavailable in a total of 31 states, 24 of which have enacted laws that ban or restrict abortion coverage in plans sold through their Marketplaces and 7 of which have no abortion coverage restrictions but also have no Marketplace plans offering it.