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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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  • The ACA’s Basic Health Program Option: Federal Requirements and State Trade-Offs

    Report

    The Patient Protection and Affordable Care Act (ACA) gives states the option to implement a Basic Health Program (BHP) that covers low-income residents through state-contracting plans outside the health insurance marketplace, rather than qualified health plans (QHPs). In March 2014, the Centers for Medicare & Medicaid Services (CMS) issued final regulations on the requirements for a BHP and the methodology for calculating federal payments to states. States can choose to implement BHP beginning in 2015.…

  • Following Midterms, Both Democrats and Republicans Expect Washington to Continue to Debate the Affordable Care Act, But the Public Is Splintered Over What Congress Should Do

    News Release

    About Half of Uninsured Expect To Find Coverage in the Coming Months, Though Another Quarter Say They Won't Because They Do Not Believe They Can Find an Affordable Plan Following the Nov. 4 midterm elections that saw Republicans seize control of the Senate and expand their House majority, nearly half of Americans (47%) expect increased debate between the two parties over the Affordable Care Act, according to the Kaiser Family Foundation's latest tracking poll. In comparison,…

  • Assessing the Performance of the U.S. Health System

    Issue Brief

    Health spending growth has consistently outpaced U.S. economic growth and is higher than medical spending in other wealthy countries. Despite spending more, the United States doesn't have better health outcome in terms of life expectancy, mortality rates and other measures. This brief provides an overview of trends in health costs and the performance of the U.S. health system, including comparisons to countries from the Organisation for Economic Co-operation and Development (OECD). The brief charts growth…

  • Why Public Interest Is Cooling in Obamacare as a Political Story 

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman reviews indicators pointing to the Affordable Care Act cooling as a front-page issue, while hot debate continues about it among partisans and experts. All previous columns by Drew Altman are available online.

  • Implementing the ACA: Medicaid Spending & Enrollment Growth for FY 2014 and FY 2015

    Issue Brief

    This report provides an overview of Medicaid financing and Medicaid spending and enrollment growth with a focus on state fiscal years 2014 and 2015 (FY 2014 and FY 2015.) Findings are based on interviews and data provided by state Medicaid directors as part of the 14th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) survey with Health Management…

  • The Louisiana Health Care Landscape

    Fact Sheet

    This fact sheet provides an overview of resident socio-demographic characteristics, population health, health coverage, and the health care delivery system in Louisiana both pre-Hurricane Katrina and in the era of health reform.

  • Uncompensated Hospital Care Fell by $6 Billion Nationally in 2014, Primarily in Medicaid Expansion States; However Many Hospitals Worry About Future Changes in Medicaid Supplemental Payments

    News Release

    The Affordable Care Act’s coverage expansions have benefited hospitals financially, helping to produce an overall decline nationwide in uncompensated care from $34.9 billion to $28.9 billion in 2014, according to a new analysis by the Kaiser Family Foundation. Nearly all of the decline occurred in Medicaid expansion states, where uncompensated care costs were $10.8 billion in 2014 – down $5.7 billion, or 35 percent, from 2013, the year before ACA coverage expansions took full effect. The…

  • Two Year Trends in Medicaid and CHIP Enrollment Data: Findings from the CMS Performance Indicator Project

    Issue Brief

    This brief provides an overview of recent trends in Medicaid and CHIP enrollment as of January 2016, based on data from the Centers for Medicare and Medicaid Services (CMS) produced as part of its Performance Indicator Project. The project was designed to provide timely data on Medicaid and CHIP eligibility and enrollment that are intended to help strengthen data-driven program management and oversight efforts at both the national and state level. They also provide insight…