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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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  • Democrats Like Medicare-for-All, but Swing Voters Don’t

    From Drew Altman

    Medicare-for-all is popular with Democrats in battleground states, but not with swing voters. In this Axios column, Drew Altman discusses the implications of the KFF-Cook Political Report poll findings. 

  • Implications of the Expiration of Medicaid Long-Term Care Spousal Impoverishment Rules for Community Integration

    Issue Brief

    To financially qualify for Medicaid long-term services and supports (LTSS), an individual must have a low income and limited assets. In response to concerns that these rules could leave a spouse without adequate means of support when a married individual needs LTSS, Congress created the spousal impoverishment rules in 1988. Originally, these rules required states to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when…

  • Questions about Prescription Drug Importation? KFF Has Answers

    News Release

    With lowering prescription drug costs a top priority for Americans, the Trump Administration, presidential candidates, members of Congress, and several states are proposing to allow the importation of drugs from abroad, chiefly Canada. The idea of allowing drugs to be imported from Canada and other countries is popular with Americans across the political spectrum, but has yet to be implemented due to concerns about safety, and strong opposition from the drug industry. A new KFF…

  • POSTPONED – The ACA at 10: What We’ve Learned from the States and How the 2020 Elections Could Shape the Future

    Event Date:
    Event

    THIS EVENT HAS BEEN POSTPONED. This planned March 18 public forum organized by the Kaiser Family Foundation and the National Academy for State Health Policy public forum has been postponed. Additional information will be posted as it becomes available. The event would have featured two panel discussions examining the Affordable Care Act's impact on states and potential changes on the horizon. The first panel includes officials from five states and will explore how states approached…

  • Pre-Existing Condition Prevalence for Individuals and Families

    Issue Brief

    This analysis estimates that almost 54 million people – or 27% of all adults under 65 —have pre-existing health conditions that would likely have made them uninsurable in the individual markets that existed in most states before the Affordable Care Act. Almost half (45%) of non-elderly families include at least one adult with such a pre-existing condition. The analysis also includes estimates by age, state and gender.

  • 10 Key Questions on Public Option Proposals

    Issue Brief

    This issue brief presents ten, high-level key questions regarding current public option proposals supported by both Democratic presidential candidates and Members of Congress.

  • The ACA is Doing Fine Without a Mandate Penalty

    From Drew Altman

    In an Axios column, Drew Altman explains that the elimination of the Affordable Care Act’s individual mandate penalty has had little impact on how the ACA’s insurance markets are working, showing that “the marketplaces continue to function, even when 'severed' from the mandate penalty,” and undercutting a central argument in the lawsuit seeking to strike down the entire law.