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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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  • Expanding Medicare to Adults at Age 60 Years—Medicare-for-More?

    Perspective

    In this column for the JAMA Health Forum, Larry Levitt examines the implications of lowering Medicare’s age of eligibility, which is emerging as a potential pathway toward Medicare-for-all or a public option among single-payer advocates. He explores the implications for costs, industry, people and broader reform efforts.

  • Coverage of Contraceptive Services: A Review of Health Insurance Plans in Five States

    Report

    The Patient Protection and Affordable Care Act (ACA) requires most private plans to provide coverage for women’s preventive health care, including all prescribed FDA-approved contraceptive services, without cost sharing. To better understand how this provision is being implemented by health plans, Kaiser Family Foundation (KFF) staff, with the Lewin Group, reviewed the insurance plan coverage policies for 12 prescribed contraceptive methods (excluding oral contraceptives). This report presents information from 20 different insurance carriers in five…

  • The Pennsylvania Health Care Landscape

    Fact Sheet

    The Affordable Care Act (ACA) went into full effect on January 1, 2014, ushering in health insurance reforms and new health coverage options in Pennsylvania and elsewhere across the country. Pennsylvania is experiencing changes to its health care delivery system as the state expands Medicaid, provides new coverage options through the federal health insurance marketplace, streamlines application and enrollment processes for coverage programs, and implements new health care delivery system and payment reforms. This fact…

  • Analysis of 2016 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces

    Issue Brief

    This analysis provides an early look at premium changes for individuals in the health insurance marketplaces, created under the Affordable Care Act (ACA), in major cities in 10 states plus DC. Premium changes for the benchmark silver plans vary significantly across the sample cities. The benchmark rates will increase 4.4 percent on average in 2016 without accounting for tax credits, a relatively modest amount but greater than the average increase for 2015.

  • 2015 Survey of Health Insurance Marketplace Assister Programs and Brokers

    Report

    This nationwide survey analysis of Marketplace consumer assistance programs and brokers examines the nature of Marketplace assistance during the second open enrollment period for 2015 coverage, and offers unique insights into how Affordable Care Act (ACA) implementation is progressing, what is changing, and what challenges remain. Building upon our Survey of Health Insurance Marketplace Assister Programs (2014), the analysis compares Assister Program capacity and experiences from the first open enrollment period to the next, and…

  • Survey Finds Many Primary Care Physicians Have Negative Views of the Use of Quality Metrics and Penalties for Unnecessary Hospital Readmissions 

    News Release

    Primary Care Providers View Health IT as Improving Quality, But Tilt Negatively on ACOs Half of the nation's primary care physicians view the increased use of quality-of-care metrics and financial penalties for unnecessary hospitalizations as potentially troubling for patient care, according to a new survey from The Commonwealth Fund and the Kaiser Family Foundation. Fifty percent of primary care physicians say the increased use of quality metrics to assess provider performance is having a negative…

  • Medicaid: What to Watch in 2018 from the Administration, Congress, and the States

    Issue Brief

    Medicaid provides health insurance coverage for about one in five Americans and is the largest payer for long-term care services in the community and nursing homes. Efforts in 2017 to repeal and replace the Affordable Care Act (ACA) and cap federal financing for Medicaid were unsuccessful but help to set the stage for 2018. As 2018 begins, there is a focus on administrative actions using Medicaid Section 1115 demonstration waivers, state actions on Medicaid expansion,…

  • Poll: Public Mixed on Whether Medicaid Work Requirements Are More to Cut Spending or to Lift People Up; Most Do Not Support Lifetime Limits on Benefits

    News Release

    Ahead of the Midterms, Voters across Parties See Costs as their Top Health Care Concern At a time when the Trump Administration is encouraging state efforts to revamp their Medicaid programs through waivers, the latest Kaiser Family Foundation tracking poll finds the public splits on whether the reason behind proposals to impose work requirements on some low-income Medicaid beneficiaries is to lift people out of poverty or to reduce spending. The Centers for Medicare and…

  • Red-State Changes Could Strengthen ACA, Medicaid

    From Drew Altman

    In an Axios column, Drew Altman discusses how, ironically, efforts by red states to move their ACA marketplaces and their Medicaid programs in  more conservative directions could end up strengthening the ACA and Medicaid politically over the longer term.