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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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  • 4.7 Million Uninsured Adults Could Become Eligible for Medicaid by 2021 if All Remaining States Expanded the Program under the ACA

    News Release

    About 4.7 million uninsured adults could gain eligibility for Medicaid by 2021 if the 14 remaining non-expansion states were to expand Medicaid under the Affordable Care Act, a new KFF analysis finds. That figure includes an estimated 2.8 million adults who already were uninsured prior to the coronavirus pandemic and would fall in the “coverage gap” – meaning they have incomes too high to qualify for Medicaid but too low for ACA marketplace subsidies –…

  • Analysis Examines the Affordable Care Act’s Impact on Nearly All Americans

    News Release

    A week after the 2020 elections, the Supreme Court is scheduled to hear arguments on a legal challenge, supported by the Trump administration, that seeks to overturn the Affordable Care Act, an outcome that would have major effects throughout the health care system as the law’s provisions have affected nearly all Americans in some way. A KFF analysis examines key provisions of the 2010 law that have changed the nation’s health care system, including what’s…

  • Health Spending for 60-64 Year Olds Would Be Lower Under Medicare Than Under Large Employer Plans

    Issue Brief

    During the presidential campaign, President Biden proposed to lower the age of Medicare eligibility from 65 to 60. This analysis uses claims data for covered medical services from both large employer plans and traditional Medicare to illustrate the potential spending effects of using Medicare payment rates in lieu of higher rates paid by employer plans for people 60-64 who shift from large employer plans to Medicare.

  • Filling the Coverage Gap: Policy Options and Considerations

    Issue Brief

    This issue brief examines some of the other options policymakers may consider to extend coverage to people in the gap, including increased fiscal incentives for states, a narrower public option, and making people with incomes below the poverty level eligible for enhanced ACA premium subsidies.

  • What Are Some Policy Options for Reaching the 2.2 Million Uninsured People in the ACA’s “Coverage Gap”?

    News Release

    A new KFF issue brief explores several potential policy options that would help close the Affordable Care Act’s "coverage gap," including providing further new incentives for states to expand Medicaid, creating a new "public option" or extending ACA Marketplace premium subsidies to low-income people who don’t currently qualify for federal help. At stake is affordable health coverage for 2.2 million uninsured people with incomes below the federal poverty level ($12,880 annually for an individual in…

  • Corporate Leaders Are Getting Bullish On Government Action On Health Care Costs

    From Drew Altman

    In this Axios column, Drew Altman explores whether the long struggle with rising health costs has caused the tide to turn in corporate leaders’ attitudes towards government involvement in controlling health spending and whether it is part of a larger shift in comfort with government action to solve problems.

  • Lowering the Age of Medicare Eligibility Would Likely Reduce Health Spending for Employers, But Raise Costs for the Federal Government by Covering More People in Medicare

    News Release

    Two new KFF analyses find that lowering the age of Medicare eligibility from 65 to 60 could significantly reduce health spending for employers, who could potentially pass savings to employees in the form of lower premiums or higher wages. Additionally, per person health spending for older adults who move from employer coverage on to Medicare would likely be lower, though such moves would shift costs to taxpayers and increase Medicare program expenditures overall. President Biden…