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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  • Health Coverage for the Hispanic Population Today and Under the Affordable Care Act

    Report

    The more than 50 million Hispanics living in the United States make up 17 percent of the total population and are the nation's fastest growing racial or ethnic group. Many Hispanics continue to face disparities in health coverage and care, and they have the highest uninsured rate among racial/ethnic groups, with nearly one in three lacking coverage. This brief provides an overview of the Hispanic population in the U.S., their health coverage today and the…

  • 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…

  • Public Opinion on the ACA: Cruising or Turbulent Ride?

    Perspective

    Regular readers of the Kaiser Health Tracking poll know by now that public opinion on the Affordable Care Act (ACA) has been at a steady cruising altitude since it was signed into law on March 23, 2010, with a little over four in ten viewing the law favorably and a similar share unfavorably. But, has public opinion on the law since passage been more turbulent for different groups of Americans, for example, those with lower…

  • Kaiser Poll: Early Reaction to Supreme Court Decision on ACA

    Perspective

    Following last week's Supreme Court's decision upholding the heart of the Affordable Care Act (ACA), a majority of Americans (56 percent) now say they would like to see the law's detractors stop their efforts to block its implementation and move on to other national problems. In the first of two polls to be released this month looking at opinion on the ACA in the wake of the Court's decision, Democrats overwhelmingly say opponents should move…

  • How the ACA Changes Pathways to Insurance Coverage for People with HIV

    Perspective

    There are multiple sources of insurance coverage and care for people with HIV in the United States.  These include public programs, such as Medicaid and Medicare, and the Ryan White HIV/AIDS program, as well as private coverage through an employer or in the individual market. Medicaid, the nation's principal safety-net health insurance program for low-income Americans, is estimated to cover the largest share of people with HIV. Fewer are covered by Medicare, the federal health…

  • 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…

  • Data Note: A Snapshot of Public Opinion on the Individual Mandate

    Poll Finding

    For the two years since the law's passage, and during the debate leading up to it, the individual mandate has been one of the most controversial aspects of the law. As the lawyers, policy makers, ACA opponents and supporters focus intently on the Supreme Court hearings, this Data Note looks at what the general public thinks of the mandate, explores the reasons why favorability ratings have been so low, and suggests that while opinion on…

  • 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…

  • My husband and I are retired. He just turned 65 and is now covered by Medicare, but I am 62 and I don’t have health insurance. Can I enroll in Medicare as his spouse? Can I sign up for a Marketplace plan?

    FAQs

    Although your husband now qualifies for Medicare, you will not qualify for Medicare until you turn 65. If you do not have health insurance now, you can consider signing up for a Marketplace plan. If your expected household income is at least 100% of the federal poverty level ($21,150 for a couple in 2026), you may qualify for premium tax credits to reduce your cost of a Marketplace policy. If your expected household income is…