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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

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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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  • Understanding The Medicaid And CHIP Maintenance of Eligibility Requirements

    Fact Sheet

    This fact sheet examines the provisions in the Patient Protection and Affordable Care Act (ACA) that require states to maintain eligibility and enrollment standards for Medicaid and the Children's Health Insurance Program. These maintenance of eligibility (MOE) provisions were designed to keep Medicaid and CHIP coverage stable until coverage expands under the health reform law. Under the MOE provisions, to receive federal Medicaid funds, states cannot impose eligibility and enrollment policies that are more restrictive…

  • Connecting Eligible Immigrant Families to Health Coverage and Care: Key Lessons from Outreach and Enrollment Workers

    Issue Brief

    Beginning in 2014, health coverage options will significantly expand under health reform through an expansion in Medicaid eligibility and by making tax credits available to help individuals purchase coverage through new Health Benefit Exchanges. Given their high uninsured rate and limited access to private and public coverage, one group who could significantly benefit from this coverage expansion is lawfully residing immigrant families. However, it will be important to address barriers eligible immigrant families often face…

  • Financial Alignment Models for Dual Eligibles: An Update

    Issue Brief

    The nearly nine million dual eligibles who receive both Medicare and Medicaid benefits are a high cost, high need population, accounting for a disproportionate share of expenditures relative to their enrollment in both programs. In April 2011, the Centers for Medicare and Medicaid Services (CMS) announced the award of design contracts to 15 states to develop service delivery and payment models to integrate care for dual eligibles. CMS and the participating states have recognized that…

  • Pulling it Together: How the ACA Can Help The Homeless

    From Drew Altman

    Estimates are that there are approximately 630,000 people who are homeless on any given night in the U.S. -- about two-thirds in shelters and one-third on the street or without real shelter. Several million people are estimated to experience homelessness over the course of a year. About two-thirds are individuals and the balance are in families. These numbers are virtually identical to national estimates we used when I worked intensively on the issue of homelessness in the…

  • Quantifying the Effects of Health Insurance Rate Review

    Report

    This report from the Kaiser Family Foundation analyzes the effect of government efforts to ensure that insurance premium increases are justifiable and provide value to consumers and small businesses. Rate review programs require insurers in the small group and individual markets to submit proposed rate increase requests to state or federal regulators, who determine if the requests are reasonable. The report finds that one out of every five requests submitted to states in 2011 resulted…

  • Covering the Uninsured: Options for Reform

    Issue Brief

    Download PDF Key Facts on the Uninsured In 2007, 45 million nonelderly people in the United States lacked health coverage More than eight in ten uninsured people (81%) come from working families About two-thirds of the nonelderly uninsured are from low-income families (income below 200% of poverty, about $42,400 for a family of 4 in 2007) More than one in three people (35%) living in poverty are uninsured, compared with one in twenty people (5%)…

  • Pulling it Together from Drew Altman: Multiple Agendas for Controlling Health Care Costs

    Perspective

    In what would be a domestic policy trifecta, we may be headed for interconnected big debates about economic recovery, entitlement programs and health reform. A core issue in the entitlement and health reform debates is the problem of rising health care costs. President Obama, now apparently fully briefed on the economic, budget and health reform realities he faces, is talking conspicuously about hard choices that may lie ahead. In a short period of time the…

  • In Depth Analysis of Health Reform Issues

    Report

    These reports provide in-depth analysis related to the health reform debate. Additional reports will be added as they become available. Medicaid Expansion in Health Reform: National and State Estimates of Coverage and CostsThis analysis and public briefing examine the potential national and state-by-state impacts on Medicaid enrollment and spending of the expansion of coverage for low-income adults under the health reform law. Reform Calculator Estimates Premiums and Subsidies Available In 2014The Foundation's interactive health reform…

  • Health Reform: Lessons From Massachusetts

    Event Date:
    Event

    As Congress debates comprehensive national health reform, the Kaiser Family Foundation has two reports and an updated fact sheet that examine state-level health reform in Massachusetts and the lessons it offers for policymakers in Washington. Consumers’ Experience in Massachusetts: Lessons For National Health Reform and In Pursuit of Affordable Health Care: On the Ground Lessons from Families in Massachusetts, examine the impact of health reform on the lives of ordinary people in the state, including…

  • Pulling it Together: Simple Arithmetic

    Perspective

    This week we put out our annual benchmark survey of employer health coverage and costs. Two numbers jumped off the pages. The first number was the average cost of a family health insurance policy in 2009: $13,375. To put that number in context, if you are an employer, you can hire an employee at the minimum wage for about $15,000 per year. If you are a consumer, you can rent an average two-bedroom apartment nationwide…