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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 Care Reform Newsmaker Series: Sen. Orrin Hatch

    Event Date:
    Event

    This May 7, 2009 webcast features Sen. Orrin Hatch (R-Utah), senior member of the Senate Committee on Finance, and ranking Republican on the panel’s Subcommittee on Health Care. The briefing was part of the Health Care Reform Newsmaker series sponsored by the Kaiser Family Foundation, Families USA and the National Federation of Independent Business. The reporters-only briefings, designed to inform the public about prospects and options for health reform, feature a short presentation by an…

  • Pulling it Together: REPOR(t)

    Perspective

    In today’s column I investigate a somewhat lighter topic than my last column on micro-simulation modeling: What was the impact of shows like Jon Stewart’s The Daily Show and Stephen Colbert’s The Colbert Report on the health reform debate?  Who among us has not wondered about the answer to this question?  Please don’t answer that. I should start by acknowledging that I am a frequent but not religious viewer of these shows, and believe that…

  • Pulling It Together: Health IN the Economy

    Perspective

    I am writing this Pulling It Together column about this one chart and its potential interpretations and implications. Source: Key Findings: Kaiser Health Tracking Poll: Election 2008 -- April 2008, Kaiser Family Foundation, April 2008. This chart from our most recent tracking poll shows the economy rising as a political issue and health care falling, with Iraq in the middle. Findings from other polling groups will show the same thing for as long as the economy…

  • How Private Health Coverage Works: A Primer – 2008 Update

    Issue Brief

    How Private Health Coverage Works: A Primer— 2008 Update This primer explains the role and operations of private health coverage in the United States. Private health coverage is provided under a variety of different arrangements, including health insuring organizations regulated under state law and health plans sponsored by employers and employee organizations that operate under the federal Employee Retirement Income Security Act (ERISA). The primer discusses the fundamental aims of private health coverage and sorts out…

  • Pulling It Together: What Do We Want Health Insurance To Be?

    Perspective

    Trends in the health insurance marketplace show substantial growth in high deductible health plans, especially among smaller firms, where 35% of workers are now covered by plans with a deductible of $1,000 or more. That's according to our recently released employer health benefits survey, which we have been conducting now for ten years. The majority of these plans are simply high deductible health plans; only a minority are so-called "consumer driven" plans with savings accounts.…

  • Community Health Centers in an Era of Health System Reform and Economic Downturn: Prospects and Challenges

    Issue Brief

    This issue brief reviews the role of community health centers in the nation's health care safety net. The centers provided comprehensive primary care to 16.1 million patients in 2007, many of them from lower-income families and medically underserved communities. The role of the centers is even more critical during an economic recession when families are more vulnerable to economic loss and unmet health needs. Issue Brief (.pdf)

  • Coverage of Low-Income Children: Key Issues to Consider in Health Reform

    Issue Brief

    A key element of health reform will be meeting the needs of low-income children. Overall, a major goal of proposals is to expand coverage by building on Medicaid, providing subsidies to low- and moderate-income individuals to buy coverage through new health insurance exchanges, and requiring individuals to obtain coverage. Current proposals also could significantly change coverage for some children already eligible for Medicaid and CHIP. This issue brief examines several key issues to consider about…

  • Who Will be the H&R Block and TurboTax for Health Insurance?

    Perspective

    There's been quite a bit of focus lately insofar as these issues go, anyway on health insurance agents and brokers (sometimes known in the industry as "producers"). They are pushing legislation that has been introduced in Congress and is now being studied by the National Association of Insurance Commissioners that would exempt agent and broker commissions for health insurance from minimum medical loss ratio (MLR) thresholds established in the health reform law. (The MLR is…

  • Measuring the Affordability of Employer Health Coverage

    Perspective

    A recent draft regulation issued by the Treasury Department describes who is eligible for premium tax credits to help them afford coverage offered through health insurance exchanges beginning in 2014. Tax credits will be available to people with incomes between 100 and 400 percent of the poverty level who are not eligible for public coverage such as Medicaid or Medicare and who are not offered affordable health coverage by an employer. The approach that the…

  • KFF/Harvard Survey on Public’s Health Care Agenda for the 112th Congress Finds An Uptick in Public Opposition to Health Reform As GOP Ramped Up Repeal Campaign

    Perspective

    Though the public remains divided on health reform overall, according to a new survey jointly conducted by the Kaiser Family Foundation and Harvard School of Public Health, opposition to the new law ticked upward in January from 41 percent to 50 percent as Republicans ramped up efforts to repeal it. The survey also showed that there is no groundswell of public support for overturning the law, with 47 percent wanting to either expand the law…