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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  • 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…

  • Insurance Markets in a Post-King World

    Perspective

    This perspective addresses how insurance markets might respond if the US Supreme Court sides with the plaintiffs in the King v. Burwell case. The case challenges the legality of premium and cost-sharing subsidies for low- and middle-income people buying insurance in states where the federal government rather than the state is operating the marketplace under the Affordable Care Act (ACA).

  • Medicare Spending Cuts and Hospital Productivity Gains

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman and guest co-author Dana Goldman examine hospital productivity gains, and what they may mean for hospitals’ ability to absorb spending reductions. All previous columns by Drew Altman are available online.

  • Medicare Spending Cuts and Hospital Productivity Gains

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman and guest co-author Dana Goldman examine hospital productivity gains, and what they may mean for hospitals’ ability to absorb spending reductions.

  • The Health-Care Enrollment Story Is in the States

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman examines the variation among states beneath the national Affordable Care Act’s Marketplace enrollment numbers released by the U.S. Department of Health and Human Services. All previous columns by Drew Altman are available online.

  • The Health-Care Enrollment Story Is in the States

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman examines the variation among states beneath the national Affordable Care Act’s Marketplace enrollment numbers released by the Department of Health and Human Services.

  • Are Uninsured Adults Who Could Gain Medicaid Coverage Working?

    Fact Sheet

    As additional states consider whether to implement the ACA Medicaid expansion, some have raised pursuing waiver authority to tie Medicaid eligibility for adults under the expansion to work requirements. This fact sheet profiles uninsured adults who could gain Medicaid coverage under the ACA by their relationship to the workforce and job-based coverage.

  • An Overview of Actions Taken by State Lawmakers Regarding the Medicaid Expansion

    Fact Sheet

    The ACA Medicaid expansion has garnered different responses from statelawmakers - Democratics and Republicans as well as governors and legislatures. While it does not cover how every state has enacted the ACA Medicaid expansion, this fact sheet highlights some of the different actions state lawmakers have taken in response to the ACA Medicaid expansion.