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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.

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

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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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  • How Marketplace Costs and Premiums Will Change if American Rescue Plan Subsidies Expire

    News Release

    In a new Policy Watch, KFF analysts explore the potential impact of the expiration of the American Rescue Plan Act’s enhanced financial help and new eligibility for the Affordable Care Act’s health insurance Marketplace federal subsidies. While the COVID-19 relief legislation passed earlier this year provides greater subsidy assistance through 2022, Democrats in Congress are currently considering making the temporary federal help permanent or extending it as part of their planned budget reconciliation legislation. The…

  • Medicaid Coverage and Care for the Homeless Population: Key Lessons to Consider for the 2014 Medicaid Expansion

    Report

    Beginning in 2014, the Affordable Care Act ACA provides for a significant Medicaid expansion uninsured, low-income adults. Given their low incomes and high uninsured rate, individuals experiencing homelessness could significantly benefit from this expansion. However, it will be important to address the barriers they face to enrolling in coverage and accessing needed care. This report, based on eight focus group discussions with administrators and frontline workers serving the homeless population in four cities, identifies enrollment…

  • Medicare Now and in the Future

    Issue Brief

    Download PDF Issue Medicare is a valuable source of health insurance for nearly 45 million Americans – mainly seniors ages 65 and older, but also 7 million younger adults with permanent disabilities.  Before Medicare was signed into law in 1965, about half of all seniors lacked hospital insurance.  Today, virtually all people ages 65 and over are covered by Medicare.  Medicare is a popular program, but faces a number of issues and challenges in the…

  • Women’s Health and Election 2008

    Issue Brief

     Download PDF Women consistently cite health care as one of the top issues they want the Presidential candidates to address, reflecting their experiences with the health care system as patients, mothers, and caregivers for frail and disabled family members.  Women’s priorities for health care reform cut across many critical topics, including health insurance coverage and affordability, the cornerstones of the candidates’ health proposals, as well as long-term care, delivery system issues, and reproductive health.  This…

  • Today’s Topics In Health Disparities: Is the Health Care System Ready for Health Reform?

    Event Date:
    Event

    On Wednesday, November 4, at 1 p.m. ET, this Today's Topics In Health Disparities live webcast examined how ready the health care system is for the influx of newly covered individuals that health reform aims to deliver. In the health care proposals being considered by Congress, changes to Medicaid alone could mean as many as 15 million people would become newly eligible for the program and many live in medically underserved areas. The program will…

  • Policy and Political Implications of the Supreme Court Case on the Affordable Care Act

    Event Date:
    Event

    This webcast features a Kaiser Family Foundation briefing held on March 14, 2012, examining the policy and political implications of the pending U.S. Supreme Court case on the Affordable Care Act (ACA). At the briefing, the Foundation released new polling data on the public’s views about the case as well as their more general views about the health reform law. Participants included: Kaiser President and CEO Drew Altman (moderator)Joe Onek, Principal, The Raben Group Sheila…

  • Pulling It Together: Moving Away From Employer Based Coverage: Don’t Forget Public Opinion

    Perspective

    One of the underlying big issues in the unfolding health reform debate is whether most Americans should continue to get insurance through work where they get it today, or purchase it themselves in the individual private health insurance marketplace. Senator McCain promotes moving to individual insurance and having individuals rather than employers make coverage decisions, as has President Bush.  But this is not only a conservative idea.  Many on the liberal side -- such as…

  • What’s in There? The New Health Reform Law and Private Insurance

    Event Date:
    Event

    This briefing focuses on how the reform law affects access to private coverage, including the new federal high-risk pools, tax credits for small businesses, health insurance exchanges, the individual mandate and employer obligations. This briefing, cosponsored by the Alliance for Health Reform and the Kaiser Family Foundation, explored these and other issues. For more information, please visit Alliance's event page. Full Video    Speakers for this session: The panel is co-moderated by Diane Rowland of…

  • Pulling It Together: What Conservatives Won In Health Reform (And Don’t Seem to Know It)

    Perspective

    Conservatives obviously don't like what they call "Obamacare" because they think it expands the role of government too much and spends too much money.  But ironically, the Affordable Care Act (ACA) actually promotes -- though not explicitly -- something that has been a fundamental objective of conservatives in health care for years: high-deductible health plans with more "skin in the game." In a new study we just released, we commissioned three different actuarial consulting firms…

  • Pulling It Together: Writing Regulations

    Perspective

    Not since Geraldo Rivera revealed the secret contents of Al Capone's vault on national TV in the mid-80s, or more recently, sports fans awaited the LeBron James "decision" about where he would play next, have we so anxiously awaited anything as much as the draft health exchange regulations just published by HHS. Well, okay, I exaggerate for effect, but the regulations on health insurance exchanges were anxiously awaited by the health policy community. The hallmark…