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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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  • Recent Studies Show That Medicaid Expansion Has Improved the Financial Performance of Hospitals and Other Providers, In Line With Prior Research

    News Release

    A KFF synthesis of recent studies finds that Medicaid expansion has been beneficial to the finances of hospitals and providers, driving decreases in the share of uninsured patients, increases in Medicaid-covered patients and declines in uncompensated care. By financing coverage for low-income people who are likely to otherwise be uninsured, Medicaid expansion provides potential economic benefits to the health care providers who provide care to that population. Studies suggest that hospitals experienced higher reimbursements and…

  • Understanding the Health Provisions in the Inflation Reduction Act

    Other Post

    President Biden signed the Inflation Reduction Act of 2022 into law on August, 16, 2022. KFF has several analyses relevant to understanding the health provisions in the legislation, as well as their potential impact on people. Among other measures, the legislation for the first time requires the HHS Secretary to negotiate prices for some top-selling drugs covered in Medicare. It also requires drug companies to pay rebates if prices rise faster than inflation for drugs…

  • ¿Quién es elegible para recibir subsidios para las primas?

    FAQs

    Los subsidios para las primas están disponibles para ciudadanos estadounidenses y ciertos inmigrantes con residencia legal que adquieran cobertura en el mercado de seguros y cuyos ingresos sean al menos iguales al 100% del Nivel Federal de Pobreza (FPL) ($15.650 para un adulto soltero o $32.150 para una familia de cuatro) en 2026. Actualmente, los subsidios para las primas también están disponibles para inmigrantes con residencia legal con ingresos inferiores a $15.650 (100% del FPL…

  • Recent and Anticipated Actions to Reverse Trump Administration Section 1557 Non-Discrimination Rules

    Issue Brief

    The Biden Administration has started taking steps to reverse Trump Administration policy and regulations that significantly narrowed the implementation and administrative enforcement of Section 1557, the Affordable Care Act’s nondiscrimination provision, particularly as the regulations apply to gender identity and sexual orientation. In addition, several lawsuits challenging the regulations, which were initially issued by the Obama Administration and later substantially revised by the Trump Administration, are pending. Section 1557 prohibits discrimination based on race, color,…

  • Medicare and Dental Coverage: A Closer Look

    Issue Brief

    Medicare does not cover routine dental care and about half of Medicare beneficiaries do not have dental coverage. Some beneficiaries have dental coverage through other sources, including Medicare Advantage, but 47% of all beneficiaries have not been to the dentist in the past year and many older adults face high out-of-pocket costs for needed dental care. This brief provides new data on the share of Medicare beneficiaries with dental coverage, the share with a dental…

  • Substance Use Issues Are Worsening Alongside Access to Care

    Policy Watch

    Drug overdose deaths rose during the early part of the COVID-19 pandemic, with some of the biggest jumps occurring among people of color. This analysis breaks out drug overdose deaths by race and ethnicity for the first nine months of 2020, to the same period in each of the two prior years. It also looks at access to care issues and recent and pending legislation aimed at addressing the nation’s substance use and mental health…

  • Filling the Coverage Gap: Policy Options and Considerations

    Issue Brief

    This issue brief examines some of the other options policymakers may consider to extend coverage to people in the gap, including increased fiscal incentives for states, a narrower public option, and making people with incomes below the poverty level eligible for enhanced ACA premium subsidies.