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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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  • How Will the Uninsured in West Virginia Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in West Virginia, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in West Virginia are eligible for Medicaid or financial…

  • How Will the Uninsured in Indiana Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Indiana, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Indiana are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Kansas Fare Under the Affordable Care Act?

    Fact Sheet

    The 2010 Affordable Care Act (ACA) has the potential to extend coverage to many of the 47 million nonelderly uninsured people nationwide, including the 369,000 uninsured Kansans. The ACA establishes coverage provisions across the income spectrum, with the expansion of Medicaid eligibility for adults serving as the vehicle for covering low-income individuals and premium tax credits to help people purchase insurance directly through new Health Insurance Marketplaces serving as the vehicle for covering people with…

  • How Will the Uninsured in Georgia Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Georgia, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Georgia are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Idaho Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Idaho, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Idaho are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in South Carolina Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in South Carolina, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in South Carolina are eligible for Medicaid or financial…

  • How Will the Uninsured in Vermont Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Vermont, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Vermont are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Hawaii Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Hawaii, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Hawaii are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in the District of Columbia Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in District of Columbia, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in District of Columbia are eligible for Medicaid…

  • How Will the Uninsured in North Dakota Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in North Dakota, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in North Dakota are eligible for Medicaid or financial…