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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

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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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  • From Ballot Initiative to Waivers: What is the Status of Medicaid Expansion in Utah?

    Issue Brief

    The Utah legislature significantly changed and limited the Medicaid coverage expansion that was adopted by the voters through a ballot initiative in November 2018. This issue brief explains new provisions in Utah's recently amended Section 1115 Medicaid waiver and the additional amendments that the state has submitted to CMS, including most recently a request for enhanced ACA federal matching funds for an expansion to 138% FPL with an enrollment cap.

  • Poll: As Midterms Approach, Health Care Remains Voters’ Top Issue, But President Trump and Other Factors Also Loom Large

    News Release

    Most Florida Voters Favor Expanding Medicaid in their State, As Do Voters across All Non-Expansion States In an expansive look at the role issues and politics may play in the 2018 midterm elections, the latest KFF Health Tracking Poll continues to find health care as the top issue for voters, but large shares of voters also say candidate characteristics, President Trump, and party control over Congress will be major factors. In the last KFF tracking…

  • How Pending Health-Related Lawsuits Could be Impacted by the Incoming Trump Administration

    Issue Brief

    This brief provides an overview of current lawsuits in health policy including preventive services, abortion care, gender affirming care, Medicare drug price negotiations, nursing home staffing rules, private coverage consumer protections, and protections and health coverage for Deferred Action for Childhood Arrivals (DACA) recipients; how they may be affected by the incoming Trump administration; and the implications of their potential outcomes.

  • The Implications of the Public’s Pre-existing Condition Amnesia

    Perspective

    KFF’s Larry Levitt discusses waning awareness of the Affordable Care Act’s provisions protecting people with pre-existing conditions and examines the Republican Study Committee's budget proposal, which proposes to repeal the provisions.

  • Supreme Court Decision Limiting the Authority of Federal Agencies Could Have Far-Reaching Impacts for Health Policy

    Issue Brief

    On June 28, 2024, the U.S. Supreme Court overturned a longstanding legal precedent that required federal courts to defer to reasonable agency interpretation when statutes are ambiguous. The decision will shift many policy decisions from federal agencies to federal judges, with implications for health policy that will reverberate for years to come. This issue brief examines the decision and assesses what’s ahead.

  • The Symbolic Manipulation of Health Issues in Elections

    From Drew Altman

    KFF President and CEO Drew Altman explains why data and facts, policy plans and lists of accomplishments do not connect with many voters. Understanding the symbolic dimensions of politics and issues is critical for experts. We can reach a share of the public with facts and data but need additional strategies to reach everyone, including storytelling and trusted messengers.