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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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  • What the Actuarial Values in the Affordable Care Act Mean

    Issue Brief

    The Patient Protection and Affordable Care Act (PPACA) establishes four levels of coverage based on the concept of "actuarial value," which represents the share of health care expenses the plan covers for a typical group of enrollees. As plans increase in actuarial value – bronze, silver, gold, and platinum – they would cover a greater share of enrollees' medical expenses overall, though the details could vary across plans. The levels of coverage provided for in…

  • Health Provisions in the 2025 Federal Budget Reconciliation Law

    Issue Brief

    On July 4, President Trump signed the budget reconciliation bill, previously known as the “One Big Beautiful Bill Act,” into law. This summary provides background, description, budgetary impact and related information on the health care provisions of the law in four categories: Medicaid, the Affordable Care Act, Medicare and Health Savings Accounts (HSAs).

  • Analysis of UnitedHealth Group’s Premiums and Participation in ACA Marketplaces

    Issue Brief

    This analysis looks at how a potential withdrawal by UnitedHealth Group from the Affordable Care Act (ACA) marketplaces in 2017 could impact insurer competition and premiums, finding a significant impact in some markets, though it would have a minimal effect on the average benchmark premium nationwide, The impacts of a UnitedHealth withdrawal would vary considerably by state and market area, with a more pronounced effect in rural areas. Since UnitedHealth often is not one of…

  • Insurer Competition, Monthly Premiums Could Be Affected in Some Markets if UnitedHealth Group Exits ACA Marketplaces

    News Release

    A withdrawal by UnitedHealth Group from the Affordable Care Act (ACA) marketplaces in 2017 could have a significant impact on insurer competition and premiums in some markets, though it would have a minimal effect on the average benchmark premium nationwide, according to a new analysis from the Kaiser Family Foundation. Late last year, UnitedHealth announced that it experienced significant financial losses in ACA compliant plans and that it would decide about future participation in ACA…

  • Visualizing Health Policy: Eligibility and Coverage Trends in Employer-Sponsored Health Insurance

    Other Post

    This Visualizing Health Policy infographic looks at eligibility and coverage trends in employer-sponsored health insurance. Between 2000 and 2015, the share of workers covered by health benefits offered by their employers dropped from 63 percent to 56 percent, with some firms not offering coverage and some employees not enrolling when coverage is offered. The biggest decrease occurred among employees working for small firms (3-199 workers). Among people younger than 65, those with lower incomes continued to…

  • ACA Coverage and the Changing Labor Market: Voices from the Field

    Issue Brief

    This brief highlights voices from adult focus group participants with low and moderate incomes who gained Medicaid or Marketplace coverage following implementation of the ACA. It focuses on work, including work status, the new labor market, job benefits, and the role of ACA coverage for those with non-traditional jobs.

  • Clinton-Sanders Contest Fuels Democratic Support for Expanding Obamacare

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman discusses how the debate between Hillary Clinton and Bernie Sanders about how to get to universal coverage has generated more support among Democrats for expanding the Affordable Care Act (and less support for the law as is).

  • People with HIV Who Gained Health Coverage Under ACA Are More Comfortable Navigating Insurance Two Years Later, But Problems Persist, Others Remain Uninsured

    News Release

    A new Kaiser Family Foundation report based on focus groups conducted in five states finds people living with HIV are more comfortable with navigating health insurance two years into the Affordable Care Act’s (ACA) major coverage expansions. Those in the marketplaces and Medicaid recognize their new benefits but often continue to worry about maintaining coverage and remain concerned about its affordability, and many in states without Medicaid expansion remain uninsured. The brief takes a second…

  • Partisanship’s Grip On The Affordable Care Act

    From Drew Altman

    In this Wall Street Journal's Think Tank column Drew Altman analyzes data from an upcoming Kaiser poll and discusses how partisanship is the dominant factor shaping views of the Affordable Care Act for Republicans and Democrats enrolled in marketplace plans.

  • 5 things to know about Obamacare’s (likely) premium hikes

    Perspective

    In this guest column for VOX, the Kaiser Family Foundation's Larry Levitt examines several key factors behind the expected premium rate increases for the Affordable Care Act's marketplace plans in 2017 and what they mean for the stability of the marketplace.