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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

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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  • Community Health Centers’ Experiences in a More Mature ACA Market

    Issue Brief

    Community health centers provide comprehensive primary care services in some of the most underserved communities in the nation. This brief summarizes findings from the Kaiser Family Foundation/Geiger Gibson Program in Community Health Policy 2018 Health Center Survey to provide a snapshot of health centers’ outreach and enrollment activities as well as changes in service capacity, and overall financial condition since implementation of the ACA.

  • Poll: The ACA’s Pre-Existing Condition Protections Remain Popular with the Public, including Republicans, As Legal Challenge Looms This Week

    News Release

    Public Not Confident in President Trump’s Calls on Drug Companies to Lower Prices As a federal court considers a challenge to the Affordable Care Act’s constitutionality, the public, including most Republicans, wants protections for people with pre-existing conditions preserved, the latest Kaiser Family Foundation tracking poll finds. Large majorities of Americans say it is “very important” to retain the ACA provisions that prevent insurance companies from denying coverage based on a person’s medical history (75%)…

  • Briefing on the ACA in CA: Year One & Beyond

    Event Date:
    Event

    Continuing an effort to explore Affordable Care Act (ACA) implementation in the states, the Kaiser Family Foundation and the Blue Shield of California Foundation examined ACA implementation in California (CA) at a Sacramento, Calif. briefing and panel discussion on May 28. A state official, experts and advocates discussed issues and challenges related to implementation of the law, and the practical impact of providing coverage to roughly 4.5 million Californians who have coverage via the state…

  • Most People Enrolled in Marketplace Coverage are Satisfied with Plan’s Premiums, Cost-Sharing and Provider Networks, New Survey Finds

    News Release

      Affordability Remains Significant Concern for Many in Non-Group Plans Following the Affordable Care Act's second open enrollment period, most people enrolled in marketplace plans report being satisfied with a wide range of their plan's coverage and features, finds a new Kaiser Family Foundation survey of people who buy their own health insurance. A large majority (74%) of those in marketplace plans rate their coverage as excellent or good, the survey finds. Most (59%) also…

  • Newly Insured Californians Report Easier Access to Care Than the Uninsured

    News Release

    Low-income California adults who gained insurance coverage in 2014 had an easier time accessing health care than those who were uninsured and increased financial protection from medical bills, according to a new Kaiser Family Foundation (KFF) report. The report, funded by the Blue Shield of California Foundation and based on findings from the California sample of the 2014 Kaiser Survey of Low-Income Americans and the ACA, finds that newly-insured Californians were more likely to have…

  • How Have State Medicaid Expansion Decisions Affected the Experiences of Low-Income Adults? Perspectives from Ohio, Arkansas, and Missouri

    Issue Brief

    This brief examines the experiences of low-income adults in three states that have made varied Medicaid expansion decisions: Ohio, which adopted the ACA Medicaid expansion, Arkansas which implemented the Medicaid expansion through a “Private Option” waiver, and Missouri, which has not adopted the expansion. While Arkansas and Ohio implemented the expansion in different ways, participants in both states described how obtaining coverage improved their ability to access care, contributing to improvements in their ability to…

  • New Evidence Health Spending Is Growing Faster Again

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses new Census Department survey data showing higher health spending growth over the last four economic quarters, and raises the question: is the health spending slowdown over?