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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 Right Care at the Right Time: Are Retail Clinics Meeting a Need?

    Event Date:
    Event

    The Alliance for Health Reform and WellPoint, Inc. discuss the role of urgent care centers and retail clinics emerging within the health care system. Panelists will explore such questions as: Can savings and improved access to care be produced through alternative care settings? Will these settings reduce emergency room use for primary care? Do they have the potential to ease the shortage of primary care providers? Who is monitoring the quality of care being delivered…

  • How Much Will Medicaid Physician Fees for Primary Care Rise in 2013? Evidence from a 2012 Survey of Medicaid Physician Fees

    Issue Brief

    This brief presents 50-state data from the 2012 KCMU/Urban Institute Medicaid Physician Fee Survey. It estimates that average Medicaid fees to qualified physicians for Affordable Care Act primary care services will rise by 73 percent when the primary care fee increase takes effect on January 1, 2013, although there will be wide state variation. The paper presents data showing how states compare in their 2012 Medicaid fee levels, how Medicaid fees compared to Medicare fees,…

  • Children and Oral Health: Assessing Needs, Coverage and Access

    Issue Brief

    This policy brief highlights the prevalence of dental problems among children and examines gaps in oral health coverage and access to dental care, as well as disparities by income and race/ethnicity. It also looks at out-of-pocket costs for dental care, explains the role of Medicaid and CHIP in dental care, coverage and access for children and describes the expansion of oral health coverage for children under the Affordable Care Act. Issue Brief (.pdf)

  • Medicaid: A Primer – Key Information on the Nation’s Health Coverage Program for Low-Income People

    Issue Brief

    This Medicaid primer provides an overview of the nation's largest health coverage program, which covers more than 62 million low-income individuals, including children and families, people with disabilities and seniors who are also covered by Medicare. Medicaid also is the dominant source of the country’s long-term care financing. The program will expand significantly under the Affordable Care Act in 2014.

  • Pulling it Together: 19.7

    Perspective

    Several years ago Joanne Silberner from NPR offered some advice I liked. Joanne said that the secret to effective communication was to "have a killer anecdote and a killer number." Here is a killer number: 19.7. That's the average number of years between major attempts at health reform since Harry Truman made health reform a top priority and his plan was branded a socialist plot and soundly defeated in 1950. The chart below chronicles the…

  • Implications Of A Federal Block Grant Program For Medicaid

    Issue Brief

    This issue brief examines the broad implications of converting Medicaid to block grant financing, one of several ideas that have been put forth to help reduce the federal deficit. The paper, which does not analyze any specific proposal, notes that switching to block grant financing would fundamentally alter the Medicaid program and could have significant implications for states, localities, beneficiaries and health care providers. Issue Brief (.pdf) Related Resources: Prior Analyses of Block Grant Proposals…

  • The Innovation Center: How Much Can It Improve Quality and Reduce Costs – and How Quickly?

    Event Date:
    Event

    The new Center for Medicare and Medicaid Innovation (CMMI) seeks to test new health care payment and service delivery models that can potentially enhance quality of care for beneficiaries while reducing costs. How is the agency planning to administer its $10 billion in funding? What early projects is the center undertaking? Is there private sector evidence that its goals can be achieved? What will happen to existing innovations now being rolled out by providers and…

  • Average Annual Premiums for Family Health Benefits Top $15,000 in 2011, Up 9 Percent, Substantially More than the Growth in Worker’s Wages, Benchmark Employer Survey Finds

    News Release

    NEWS RELEASESeptember 27, 2011 Average Annual Premiums for Family Health Benefits Top $15,000 in 2011, Up 9 Percent, Substantially More than the Growth in Worker’s Wages, Benchmark Employer Survey FindsAbout 2.3 Million Young Adults Added to Parents’ Plan As a Result of Health Reform At Small Firms, One in Four Covered Workers Face Annual Deductible of $2,000 or More MENLO PARK, Calif. -- After several years of relatively modest premium increases, annual premiums for employer-sponsored…

  • A Guide to the Supreme Court’s Review of the 2010 Health Care Reform Law

    Issue Brief

    With the Supreme Court preparing to hear oral arguments about challenges to the 2010 Affordable Care Act in March 2012, this Kaiser Family Foundation brief serves as a primer on the pending case, which challenges the constitutionality both of the law's individual mandate that requires most Americans to obtain health insurance and of provisions requiring states to expand eligibility for their Medicaid programs. The brief provides an overview of the pending case, the key constitutional…

  • Designing a Marketplace that Works: Steps to Affordable Coverage

    Event Date:
    Event

    The Affordable Care Act enacted in March 2010 calls for the establishment of state health insurance exchanges — marketplaces through which individuals and small businesses can purchase affordable insurance. These exchanges must begin operation by January 1, 2014. This October 22 briefing, cosponsored by the Alliance for Health Reform and The Commonwealth Fund, looked at the options states have, and the federal government's role. For more information, please visit Alliance's event page. Full Video  …