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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

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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 Single Streamlined Application Under the Affordable Care Act: Key Elements of the Proposed Application and Current Medicaid and CHIP Applications

    Report

    The Affordable Care Act (ACA) makes a number of changes to simplify the Medicaid enrollment process. As part of these changes, beginning in 2014 all states will be required to use a single, streamlined application provided by the U.S. Secretary of Health and Human Services unless they receive approval to use an alternative application. A draft version of the streamlined application was released for public comment on January 28, 2013. This analysis provides an overview…

  • Health Homes for Medicaid Beneficiaries with Chronic Conditions

    Issue Brief

    This brief profiles four states that were the first to receive federal approval to take up a state option under the Affordable Care Act to implement health homes for Medicaid beneficiaries with chronic conditions. Almost half of the 9 million people who qualify for Medicaid on the basis of disability suffer from mental illness and 45 percent have three or more diagnosed chronic conditions. Health homes provide an important tool for states trying to manage…

  • Kaiser Health Tracking Poll — September 2011

    Feature

    The September tracking poll examines public opinion about the "super committee" and explores the views and experience of individuals who have pre-existing health conditions, in addition to continuing tracking opinion about the health reform law. Findings from the poll include: Most Americans express doubt that the congressional super committee can find the right solutions for dealing with the country’s finances. More than six in ten (62%) say they trust the super committee "just a little"…

  • Medicare Advantage 2011 Data Spotlight: Medicare Advantage Enrollment Market Update

    Issue Brief

    This data spotlight examines enrollment trends in Medicare Advantage plans in 2011 and finds that, despite concerns about the effects of the 2010 health reform payment reductions on private Medicare Advantage plans, enrollment continued to rise this year. Additionally, Medicare Advantage enrollees are paying lower premiums, on average, than they did in 2010. Preferred Provider Organizations gained more enrollees than any other plan type, while enrollment in Private Fee-for-Service plans continued to decline. A companion…

  • National and State-By-State Impact of the 2012 House Republican Budget Plan for Medicaid

    Report

    This analysis of the House Budget Plan that was passed in 2012 finds that repealing the Affordable Care Act (ACA) and converting Medicaid to a block grant would trigger significant decreases in federal Medicaid spending and could result in substantial reductions in enrollment and payments to providers compared to current projections. The analysis, conducted by the Urban Institute for the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, updates a similar study from May…

  • Kaiser Health Tracking Poll — November 2010

    Feature

    The November 2010 tracking poll was conducted in the days following the mid-term election that resulted in major gains for Republicans, including a shift in control of the House of Representatives. The survey attempts to gauge what role health reform played in voters’ decisions, and to measure the current public mood about the health reform law. The poll finds that voters say health care reform was a factor that influenced their vote, but not a…

  • Health Reform and State Workforce Challenges: An Early Look at Five States

    Report

    This report provides an early look at state efforts to prepare for health reform, examining the experiences to date in five states (Connecticut, Michigan, Massachusetts, North Carolina and Washington). The report finds that the state political environment and expected leadership transitions create uncertainties and are already factoring into state strategies on health reform implementation. State leaders dealing with an aging workforce, hiring constraints, and the toll from the recession also see a need for additional…

  • Issues for Structuring Interim High-Risk Pools

    Issue Brief

    One of the first provisions that would be implemented under federal health reform bills in the House and the Senate would establish a national high-risk pool program to offer coverage to otherwise uninsurable individuals during the interim period between enactment and implementation of broader health care reforms. High-risk pools provide a safety net for people who are denied coverage by private insurers due to their health. Most states that permit insurers to decline applicants for…

  • Chartpack: Kaiser Health Tracking Poll — November 2009

    Poll Finding

    This document contains the chartpack from the November Health Tracking Poll. The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted November 5 through November 12, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (802) and cell phone (401, including 112 who had no landline telephone) were carried out in English and Spanish. The margin of…

  • State Medicaid Agencies Prepare for Health Care Reform While Continuing to Face Challenges from the Recession

    Issue Brief

    This report, based on discussions with leading state Medicaid directors in May 2010, examines how Medicaid agencies are preparing for a lead role in implementing health reform while continuing to deal with the impact of the recession. The report augments the most recent annual Medicaid budget survey report, released in September 2009, and a mid-year update report released in February 2010. NOTE: Updated report on fiscal years 2010 and 2011 now available. Report (.pdf)