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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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  • The Sleeper in Health Reform: Long-Term Care and the CLASS Act

    Event Date:
    Event

    The Kaiser Family Foundation briefing examines a little-noticed but major provision in two leading health reform bills that would change the way that the U.S. pays for long-term care. The provision, known as the Community Living Assistance Services and Supports (CLASS) Act, would establish a national voluntary insurance program that would allow for voluntary pre-financing of long-term care through payroll deductions and then provide a cash benefit to purchase services. The briefing included a summary…

  • Quality Ratings of Medicare Advantage Plans: Key Changes in the Health Reform Law and 2010 Enrollment Data

    Issue Brief

    NEW: Foundation brief looks at implications of 2011 quality ratings for Medicare Advantage plans. This Kaiser Family Foundation issue brief examines the key changes in this year’s health reform law that will reward bonuses to private Medicare Advantage plans based on quality rating. Medicare currently rates plans on a five-star scale, with five stars representing the highest quality. The brief analyzes plans based on their quality rating for the current year and also examines enrollment…

  • The Texas Health Care Landscape

    Report

    This fact sheet summarizes the Texas health care landscape, including data on demographics, population health, the uninsured and the state Medicaid program. Fact Sheet (.pdf)

  • Family Health Premiums Rise 4 Percent to Average of $15,745 in 2012, National Benchmark Employer Survey Finds

    News Release

    Menlo Park, Calif. – Annual premiums for employer-sponsored family health coverage reached $15,745 this year, up 4 percent from last year, with workers on average paying $4,316 toward the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2012 Employer Health Benefits Survey released today. This year’s premium increase is moderate by historical standards, but outpaced the growth in workers’ wages (1.7 percent) and general inflation (2.3 percent). Since…

  • The Texas Health Care Landscape

    Fact Sheet

    This fact sheet summarizes the Texas health care landscape, including data on demographics, population health, the uninsured and the state Medicaid program. Fact Sheet (.pdf)

  • Implementing New Private Health Insurance Market Rules

    Issue Brief

    With the Jan. 1, 2014 effective date for implementing major changes in the private insurance market under the Affordable Care Act (ACA) approaching, this brief looks at three proposed federal regulations released in late November 2012 that detail how the ACA’s rules will operate in the following areas: private insurance market reforms, essential health benefits and actuarial value, and wellness programs offered or required by employers under group health plans. These regulations deal with aspects…

  • Massachusetts and Ohio: Capitated Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared

    Fact Sheet

    The Centers for Medicare and Medicaid Services (CMS) has finalized memoranda of understanding (MOUs) with Massachusetts and Ohio to test a capitated financial alignment model to integrate care and align financing for people who are dually eligible for Medicare and Medicaid in 2013. CMS also has signed an MOU with Washington to test a managed fee-for-service model. These three year demonstrations will introduce changes in the care delivery systems through which beneficiaries presently receive services…

  • Quote from KFF President and CEO Drew Altman reads, "when it comes to the “affordability crisis” driving the national discussion of health care today, the chronically ill, and most of all the chronically ill uninsured, are the tip of the spear."

    The Group that Struggles the Most in American Health Care

    From Drew Altman

    In a new column, Dr. Drew Altman, KFF's Founding President and CEO, previews findings about the chronically ill uninsured from a large KFF survey of 25,000 Americans focusing on the cost and access challenges facing the chronically ill, which will be released tomorrow. He writes: “There are more than enough needs to go around in American health care, but if I had to pick the one group that struggles the most with costs and access,…

  • 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?