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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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  • Medicare Savings in Perspective: A Comparison of 2009 Health Reform Legislation and Other Laws in the Last 15 Years

    Issue Brief

    Although Medicare is not the main focus of current health reform legislation, the bill recently passed by the House—H.R. 3962, America’s Affordable Health Choices Act of 2009—and the bill before the Senate—H.R. 3590, Patient Protection and Affordable Care Act—include a number of provisions that would affect Medicare program expenditures. This policy brief considers the proposed 10-year Medicare savings and increased spending in the two proposals in the context of other laws enacted during the last…

  • Massachusetts Health Care Reform: Six Years Later

    Issue Brief

    In 2006, then-Gov. Mitt Romney signed Massachusetts' comprehensive health reform designed to provide near-universal health insurance coverage for state residents. Building on a long history of health reform efforts, the state embarked on an ambitious plan to promote shared individual, employer, and government responsibility. This brief examines Massachusetts' experience with coverage and access to care over the last six years, as well as the state's ongoing efforts to deal with persistent high health-care costs. The…

  • Approaches to Covering the Uninsured: A Guide

    Issue Brief

    The guide explains the key strategies for expanding coverage to the nation's 45 million uninsured people and explains and how different policy options can be combined to form comprehensive reform proposals. It organizes the various policy strategies under four overall approaches: strengthening current coverage arrangements, improving the affordability of coverage, improving the availability of coverage and changing the tax treatment and financing of health insurance. Guide (.pdf)

  • Pulling it Together: This Could Be the Next Big Issue in Health Reform

    Perspective

    No, this is not about “death panels.” The town hall meetings.  The media coverage of the town hall meetings.  Media polls about how the American people feel about the town hall meetings.  And even the media myth busting and fact checking about the most extreme claims made at the town hall meetings and the Administration's daily efforts to set the record straight.  All these things have focused attention on a few hot button issues that…

  • Getting Connected: Can the ACA Improve Access to Health Care in Rural Communities?

    Event Date:
    Event

    Residents of rural communities face unique health care challenges, including fewer health care providers, higher rates of chronic disease, and lower adoption rates of health information technology. This October 13 briefing, cosponsored by the Alliance for Health Reform and the United Health Foundation, looked at the many provisions in the Patient Protection and Affordable Care Act (ACA) that speak to the needs of rural communities, with a focus on boosting the health care workforce and…

  • Coordinating Coverage and Care in Medicaid and Health Insurance Exchanges

    Issue Brief

    The Kaiser Commission on Medicaid and the Uninsured convened a roundtable discussion on August 31, 2010 with a group of national and state experts to discuss key issues related to coordinating coverage and care in Medicaid and the new Health Insurance Exchanges under health reform. The Patient Protection and Affordable Care Act requires states to create a coordinated, simple and technologically-supported process through which individuals may obtain Medicaid, Children’s Health Insurance Program and subsidized Exchange…

  • Preventing Chronic Disease: The New Public Health

    Event Date:
    Event

    There is a groundswell of activity in local communities to support healthier lifestyles and help people make long-lasting and sustainable changes that can reduce their risk for chronic diseases. A number of provisions in the health reform law are aimed directly at improving population health by addressing conditions where Americans live, learn, work, and play. Public health agencies across the nation are involved in promoting healthy life styles in their communities and the U.S. Department…

  • Online Applications For Medicaid And/Or CHIP: An Overview of Current Capabilities And Opportunities For Improvement

    Issue Brief

    This analysis provides an overview of online applications for Medicaid and/or CHIP and examines the extent to which they incorporate features that streamline and simplify the enrollment process for individuals. Thirty-two states currently offer an online application for one or both of these programs that is accessible by the public and can be electronically submitted, although they vary in their features. A key component of the Patient Protection and Affordable Care Act is the creation…

  • How Will Uninsured Children Be Affected By Health Reform?

    Issue Brief

    This brief examines uninsured children and how they could be affected by health reform, including estimates of how many might qualify for coverage under a Medicaid expansion, how many would be eligible for subsidies and how many would not be eligible for such help. Issue Brief (.pdf)

  • New Study Examines the Current Spending on Health Care for the Uninsured and Projects the Cost of Additional Medical Care if the Population Were Insured

    Report

    This study examines the current spending on care for the uninsured and projects additional medical spending if the population had health insurance coverage. The study finds that the uninsured will spend $30 billion out-of-pocket for health care in 2008 while receiving $56 billion in uncompensated care, three quarters of which will be from government sources. The study is an update of a previous Kaiser study and also projects the additional cost to the nation’s health…