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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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  • What about premiums I already paid in 2021?

    FAQs

    The higher premium subsidies are in effect for the 2021 and 2022 plan years.  For premiums you already paid in 2021, before the new law passed, you can claim the increased tax credit when you file your federal income tax return.

  • I am unemployed and receiving UI this year, but my income is low enough to qualify for Medicaid and I live in an expansion state. Can I choose between that and marketplace subsidies?

    FAQs

    No.  If you are eligible for Medicaid you cannot be eligible for marketplace subsidies.  Some people who receive UI benefits will be eligible for Medicaid, in part because Medicaid will NOT take into account the $300 per week federal supplemental UI benefits.  When you apply through the marketplace, you will receive a determination indicating whether you are eligible for Medicaid.  Medicaid coverage is also free or low cost (some states charge a nominal monthly premium…

  • I just got laid off. I am eligible for 6 months of COBRA subsidy, also eligible for Medicaid. Can I choose option that is best for me?

    FAQs

    Yes, eligibility for COBRA does not affect your eligibility for Medicaid or vice versa.  Medicaid also offers premium-free coverage (in some states Medicaid charges a nominal monthly premium for some adults) with no or nominal cost sharing.  As you consider options, you will want to compare provider networks, cost sharing, covered benefits, other plan features. If you elect COBRA, remember the subsidy ends no later than September 30, 2021.  If income remains at or below…

  • Issue Briefs and Testimony Related to Health Reform

    Issue Brief

    Issue Briefs Related to Health Reform This collection of some of our most recent and relevant issue briefs go beyond the basics to provide concise discussions and analyses of key policy topics related to health reform. For a more complete collection of all the Foundation's health reform resources, click here.Health Reform Roundtables: Charting A Course Forward Health Reform Roundtables: Charting A Course Forward is a series of discussions among federal officials, state officials and outside…

  • Optimizing Medicaid Enrollment: Perspectives on Strengthening Medicaid’s Reach Under Health Care Reform

    Issue Brief

    The health reform law creates a national plan for near-universal health coverage that relies on a large expansion of Medicaid eligibility as its foundation. This brief draws on recent interviews with Medicaid program directors and other experts about the opportunities that health reform presents to optimize Medicaid by strengthening its enrollment and renewal operations and recasting it as an affordable health coverage program for working people and families. Executive Summary (.pdf) Issue Brief (.pdf)

  • Liking the Pieces, Not the Package: Contradictions in Public Opinion During Health Reform

    Poll Finding

    Public opinion played a prominent role during the recent health care reform debate. In a published Health Affairs article, Kaiser researchers examine past and present polling and show that opinion tracked with historic patterns and was relatively stable, even if the contentious public debate suggested a volatile public mood in 2009 and 2010. Going forward, the public will begin reacting to reform implementation, primarily by judging it in terms of their perceptions of and experiences…

  • Medicaid Policy Options for Meeting the Needs of Adults with Mental Illness under the Affordable Care Act

    Issue Brief

    This paper examines the salient issues raised in a November 2010 roundtable discussion of national and state experts convened by the Kaiser Commission on Medicaid and the Uninsured, in partnership with the Bazelon Center for Mental Health Law, to discuss Medicaid policy options available under health reform to help meet the needs of adults with mental illness. The Patient Protection and Affordable Care Act will expand the Medicaid program, offering the opportunity to improve access…

  • Pulling It Together: Rising Health Costs Are Not Just a Federal Budget Problem

    Perspective

    Premiums for employer-provided health insurance, where 150 million Americans get their coverage, jumped 9% in 2011 while workers’ wages grew just 2%, according to our annual employer survey.  The average family policy now costs more than $15,000 per year, more than the cost of a Chevy Aveo or a Ford Fiesta.  Since we began doing this survey thirteen years ago, worker contributions to premiums have increased 168%, wages 50%, and inflation 38%. Critics of the…