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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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  • Americans Remain Divided on Health Reform But Are Confused About The Law And How And When It Will Affect Them

    News Release

    Many Provisions That Take Effect in 2010 Are Popular and Have Bipartisan Support Cable News Tops List of the Public’s “Most Important” Information Sources MENLO PARK, Calif. –The first Kaiser Health Tracking Poll fielded since the passage of health reform last month finds that 8 in 10 Americans know that President Obama signed the legislation  into law.  But 55 percent say they are confused about the law and more than half (56%) say they don’t yet have…

  • Explaining Health Reform: Eligibility And Enrollment Processes For Medicaid, CHIP and Subsidies in the Exchange

    Issue Brief

    The new health reform law will require most U.S. citizens and legal residents to have health coverage by 2014. It provides new options for coverage by expanding Medicaid eligibility to more low-income people and creating a state-based system of health insurance exchanges through which individuals can purchase coverage, with federal subsidies for many. This brief and accompanying explanatory chart summarize key requirements that states face under health reform to construct coordinated and consumer-friendly enrollment systems…

  • Optimizing Medicaid Enrollment: Spotlight on Technology – Louisiana’s Express Lane Eligibility

    Issue Brief

    This piece looks at how Louisiana uses “express lane eligibility" to increase and streamline the enrollment of low-income children in its Medicaid program. It is the first in a Spotlight on Technology series profiling several states' innovative applications of technology to Medicaid enrollment efforts. The series illustrates a range of approaches that states can adopt to improve their systems now and to prepare for the expansion of Medicaid under health reform. Spotlight (.pdf)

  • Side-by-Side Comparison of Major Health Care Reform Proposals

    Issue Brief

    On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, and a week later, signed into law the Health Care and Education Reconciliation Act of 2010, which made some changes to the comprehensive health reform law. Summary of Final Health Care Reform Law (.pdf) Download a printable comparison of the new health reform law (the Patient Protection and Affordable Care Act), the House-passed Health Care and Education Reconciliation Act…

  • Is ACA Coverage Affordable for Low-Income People? Perspectives from Individuals in Six Cities

    Issue Brief

    This brief presents findings from focus groups with low-income Medicaid and Marketplace enrollees in six cities: Baltimore, MD; Columbus, OH; Oakland, CA; Richmond, VA; St. Louis, MO; and Tampa, FL. It explores their experiences signing up for coverage; their perceptions of whether the costs they pay for their coverage are affordable; their experiences accessing care; and the impact of out-of-pocket costs on their ability to get needed care. It provides insights into the ongoing financial…

  • Flint Fallout: Water Supply Safety Now Near Top of Public’s National Health Concerns, Trailing Cancer

    News Release

    In the wake of the lead crisis affecting drinking water in Flint, Mich., the public now ranks contaminated drinking water among the most serious national health issues, trailing cancer, according to the April Kaiser Health Tracking Poll. When asked about a series of health issues facing the country, more than a third (35%) identify contaminated drinking water as “extremely serious,” behind cancer (43%) and similar to heroin abuse (35%)  and ahead of major diseases such…

  • 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…

  • 8 Questions & Answers about Puerto Rico

    Fact Sheet

    These slides provide a quick snapshot of Puerto Rico’s population, as well as current and upcoming issues that are impacting the island’s health care system.