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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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  • Pulling it Together: What Will Health Reform Do For Me?

    Perspective

    There is one poll number that may be more important to watch than any other if we have a big debate about health reform: The percentage of Americans who think that they or their families would be better off if the president and the Congress enacted major health reform legislation. It's a number that signals whether people think that health reform legislation will actually help them with the problems they are having in the current…

  • Pulling It Together: Are We Headed for a Government Takeover of Health Care?

    Perspective

    Remember the “government takeover of the health care system” argument that critics of the health reform law have used?  Well, last week the Office of the Actuary in the Centers for Medicare and Medicaid Services published the latest projections of health spending in the journal Health Affairs.  Attention focused mainly on the Actuary’s estimate that national health spending would grow to almost 20% of GDP by 2020 and that the Affordable Care Act (ACA) would…

  • Performance Measurement Under Health Reform: Proposed Measures For Eligibility and Enrollment Systems and Key Issues and Trade-offs to Consider

    Issue Brief

    The adoption of new eligibility and enrollment requirements under the Affordable Care Act (ACA) provides states and the federal government an important opportunity to implement a meaningful set of performance measures for eligibility and enrollment systems. Performance measures could be used at the federal level to assess state performance in meeting the ACA’s eligibility and enrollment goals, while states could use measures for program management and quality improvement. This brief seeks to inform the development…

  • Pulling it Together: 2012: The ACA, and More

    From Drew Altman

    What is remarkable about 2012 (and the current era in health policy) is how many big health policy issues and marketplace changes will be in play at the same time: HEALTH REFORM: There is the implementation of a historic but fragile health reform law, with a Supreme Court decision pending and so much hanging in the balance. MEDICARE AND MEDICAID: There are continuing debates about potentially big changes in Medicare and Medicaid, driven by the…

  • Pulling it Together: A Primer on Health in the Election

    Perspective

    There is a lot of talk in polling and political circles and some speculation in the media about the role of health reform in the midterm elections. We regularly measure what the public thinks about health reform and you see reports from our monthly tracking polls about that. But whether those opinions will translate into an impact on people’s votes in the upcoming election is an entirely different question. First, to understand what might happen in…

  • Medicaid’s New “Health Home” Option

    Issue Brief

    This brief provides key information about the new option for state Medicaid programs to provide "health home" services for enrollees with chronic conditions. The option, established under the new health reform law, took effect on Jan. 1, 2011. Health homes are designed to facilitate access to and coordination of the full array of primary and acute physical health services, behavioral health care and long-term community-based services and supports. Brief (.pdf)

  • Medicaid’s Role for Hispanic Americans

    Fact Sheet

    This fact sheet examines Medicaid's role for Hispanic Americans. It includes data on Medicaid's coverage of Hispanic Americans and the program's impact on their access to care, as well as the impacts of the recent recession and the coming expansion of Medicaid under health reform on enrollment in Medicaid among Hispanic Americans. The fact sheet also has a chart showing state-by-state data on health insurance coverage of Hispanic Americans. Fact Sheet (.pdf)

  • California's "Bridge to Reform" Medicaid Demonstration Waiver

    Fact Sheet

    This issue brief provides an overview of California's "Bridge to Reform" Medicaid Demonstration Waiver, which was approved in 2010 and will make up to roughly $8 billion in federal Medicaid matching funds available to California over a five-year period to expand coverage to low-income uninsured adults and preserve and improve the county-based safety-net. The waiver also allows the state to enroll Medicaid-eligible seniors and persons with disabilities into managed care plans that meet specified readiness…

  • Pulling It Together: Medicare, Medicaid, and The Multiplier Effect

    Perspective

    We are witnessing a battle in Washington right now about the future of health care’s two big public programs, Medicare and Medicaid. It’s a budget battle, it’s an ideological battle, it’s a partisan political battle, and while it might not always be obvious following the debate, it’s a high stakes battle for people. In 2011, over a hundred million low-income, disabled, and elderly beneficiaries will be served by the two programs. Many of the proposals…

  • Report Finds State Costs of Implementing The Affordable Care Act’s Medicaid Expansion Would Be Modest Compared to Increases in Federal Funds, and Some States Would See Net Savings

    News Release

    Washington, D.C. – A new report released today by the Kaiser Family Foundation shows modest state costs for implementing the Medicaid expansion under the Affordable Care Act compared to significant increases in federal funds, allowing some states to see net budget savings even as millions of low-income uninsured Americans gain health coverage. The new, updated analysis, conducted by John Holahan, Matt Buettgens, Caitlin Carroll and Stan Dorn at the Urban Institute for the Foundation's Commission…