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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

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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  • The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States

    Issue Brief

    This brief examines the early state budget effects of the ACA Medicaid expansion in three states: Connecticut, New Mexico, and Washington State. States were asked about savings and costs in Medicaid, behavioral health, corrections, uncompensated care spending, etc. as well as revenues. Findings from a study looking at Kentucky are also included.

  • Health-Care Deductibles Climbing Out of Reach 

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman explores the trend of higher deductibles in health plans and discusses a new analysis showing that many people with insurance don’t have sufficient financial resources to pay a mid- or high-range deductible. All previous columns by Drew Altman are available online.

  • Health-Care Deductibles Climbing Out of Reach

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman explores the trend of higher deductibles in health plans and discusses a new analysis showing that many people with private insurance don’t have sufficient financial resources to pay a mid- or high-range deductible.

  • Consumer Assets and Patient Cost Sharing

    Issue Brief

    Higher cost sharing in private insurance has been credited with helping to slow the growth of health care costs in recent years. For families with low incomes or moderate incomes, however, high deductibles, out-of-pocket limits and other cost sharing can be a potential barrier to care and may lead these families to significant financial difficulties. This issue brief uses information from the Federal Reserve Board's 2013 Survey of Consumer Finances to look at how household…

  • Medicaid Moving Forward

    Issue Brief

    Medicaid is the nation’s main public health insurance program for people with low incomes, and it is the single largest source of health coverage in the U.S., covering nearly 70 million Americans. Medicaid also finances 16% of total personal health spending in the nation. States design and administer their own Medicaid programs within federal requirements, and states and the federal government finance the program jointly. As a major payer, Medicaid is a core source of…

  • ACA 101: What You Need To Know

    Event Date:
    Event

    On Friday, March 6, 2014, the Kaiser Family Foundation and the Alliance for Health Reform hosted an ACA 101 briefing on the Affordable Care Act. The briefing took place just as the second marketplace enrollment period ended, and the Supreme Court heard oral arguments in a case challenging the ACA's subsidies (King v Burwell).

  • If Health Insurance Subsidies Are Struck Down, States Will Need Time

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman explores a practical timetable for state action if the Supreme Court rules in favor of the plaintiffs in King V. Burwell and ponders what Republicans in Congress might do.

  • The Coverage Provisions in the Affordable Care Act: An Update

    Issue Brief

    This brief examines the coverage provisions of the Affordable Care Act , providing an update on how they have been implemented and assessing their impact five years after the law's enactment. It also discusses key issues for coverage going forward.

  • New Kaiser Policy Insight and Issue Brief Examine Policy Implications and Legal Arguments in the U.S. Supreme Court’s King v. Burwell Case

    News Release

    With the Supreme Court set to hear oral arguments in King v. Burwell on March 4, a new Policy Insight from the Kaiser Family Foundation's Larry Levitt and Gary Claxton explores the policy implications for consumers and insurance markets if the Court were to side with the plaintiffs in the challenge to the Affordable Care Act’s consumer subsidies. A second issue brief by KFF’s MaryBeth Musumeci, a policy analyst and an attorney, explains the legal…