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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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  • Findings from the Field: Medicaid Delivery Systems and Access to Care in Four States in Year Three of the ACA

    Issue Brief

    Based on case studies and focus groups, this brief reviews delivery systems and access to care for Medicaid enrollees in Colorado, Connecticut, Kentucky, and Washington as of Spring 2016. The findings provide an on-the-ground view of Medicaid delivery systems and enrollees’ experiences accessing care three years after implementation of the Medicaid expansion. This brief builds on previous reports that examined states’ preparation for implementation prior to the initial ACA open enrollment period and their experiences…

  • The Missing Debate Over Rising Health-Care Deductibles

    From Drew Altman

    In this Wall Street Journal Think Tank column, Drew Altman discusses what may be the most important change in the American health system—hint it’s not the Affordable Care Act—which has occurred without much discussion.

  • Quick Takes: Timely insights and analysis from KFF staff

    ACA Preventive Services at the Supreme Court

    Quick Insights

    If the Court rules in favor of Braidwood, private health insurers would no longer be required to cover, without cost sharing, certain preventive services recommended by USPTF after 2010 when the ACA was enacted.

  • More Than Half of the Public Worries Federal Medicaid Budget Cuts Would Affect Their Family’s Ability to Obtain and Afford Care; More Worry It Will Increase the Uninsured 

    News Release

    As Congress weighs spending cuts and other changes to Medicaid, more than half (54%) of the public say they are worried significant reductions in federal Medicaid spending would negatively affect their family’s ability to obtain and afford health care, a new KFF Health Tracking Poll finds. This includes about three in 10 (29%) who say they are “very worried” about such an outcome.  Democrats (69%) and independents (68%) are much more likely to say they…

  • Trends in Employer-Sponsored Insurance Offer and Coverage Rates, 1999-2014

    Issue Brief

    This issue brief uses data from the National Health Interview Survey (NHIS) to examine trends in employer-sponsored health insurance (ESI) for different of individuals and households in the United States. While ESI remains the leading source of coverage for nonelderly people, the percentage covered by an employer plan has declined over the past 15 years. A similar pattern exists with firm offer rates; fewer workers were offered health insurance from their employer in 2014 than…

  • Reaching for the Stars: Quality Ratings of Medicare Advantage Plans, 2011

    Issue Brief

    New: Medicare Advantage Plan Star Ratings and Bonus Payments in 2012 In 2012, Medicare Advantage plans will be awarded additional payments based on their quality ratings as a result of the 2010 health reform law. The Centers for Medicare and Medicaid Services has proposed a demonstration that would modify the quality-based payments for plans, providing additional payments for 2012 to 2014. This policy brief by the Kaiser Family Foundation examines the quality ratings of private…

  • The Uninsured And The Difference Health Insurance Makes

    Fact Sheet

    This fact sheet describes the characteristics of the uninsured and explains the recent increase in this population. It also examines the difference that health insurance can make and how health reform is expected to cover millions more people.

  • Promotional image for KFF video How Affordable is the Affordable Care Act

    Did the Affordable Care Act Make Health Care More Affordable?

    Video

    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?

  • Promotional image for KFF video Health Care Unaffordability at the Macro Level

    Health Care Costs Keep Rising … Why and Who Pays?

    Video

    The U.S. spends more on health care than other large, wealthy countries. Concerns about rising costs aren't new, yet somehow we keep paying the bill. In this video, KFF’s Larry Levitt explains how we got here, who bears the consequences and why reining in spending systematically may be central to the next big health care debate. KFF’s Larry Levitt, Executive Vice President for Health Policy, explains how we got here, who bears the consequences and…