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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: The Media’s Challenge In Health Reform

    Perspective

    For many years now the news media has served as the public's number one source of information on important issues like health reform. People rely on the news media to help them wade through claims and counter claims, understand how policy options will affect them and come to judgment on complex issues. In some cases the broader news media has performed admirably in explaining the sometimes overwhelming complexities of health reform, particularly in recent weeks…

  • Medicaid and State Budgets: From Crunch to Cliff

    Fact Sheet

    This fact sheet discusses the status of Medicaid and state budgets in light of the continuing recession and the federal fiscal relief provided to state Medicaid programs through the American Recovery and Reinvestment Act (ARRA). The ARRA money has proved to be critical in helping states address budget shortfalls, preserve Medicaid eligibility and soften program cuts. But ARRA funds are set to expire on Dec. 31, 2010, creating a major cliff in state financing that…

  • With Federal Support, States Hold Steady in Medicaid and CHIP Coverage Policies for Low-Income Children and Families Despite Recession

    News Release

    New 50-State Survey Finds Some States Make Targeted Expansions to Strengthen Coverage and Achieve Efficiencies as They Prepare for Health Reform WASHINGTON -- Despite tight budgets, nearly all states maintained or made targeted expansions or improvements in their Medicaid and Children’s Health Insurance Programs (CHIP) eligibility and enrollment rules in 2010, preserving the programs’ ability to provide coverage to millions of low-income Americans who otherwise lack affordable options, according to a new survey released today…

  • Determining Income for Adults Applying for Medicaid and Exchange Coverage Subsidies: How Income Measured With a Prior Tax Return Compares to Current Income at Enrollment

    Issue Brief

    A major goal of the Patient Protection and Affordable Care Act (ACA) is to significantly expand coverage and reduce the number of uninsured. Beginning in 2014, the ACA will establish a new continuum of coverage that will provide assistance to individuals with incomes up to 400% of poverty through a broad expansion in Medicaid and by making premium tax credits available to eligible individuals to purchase coverage through new Health Insurance Exchanges. The law standardizes…

  • The Health of Safety-Net Hospitals: How are They Faring? What’s the Outlook?

    Event Date:
    Event

    The Alliance for Health Reform and The Commonwealth Fund discusses the critical role of safety-net hospitals in providing care to vulnerable populations. Panelists will explore such questions as: Who does the safety-net system currently serve and how will this patient mix change as the health reform law plays out? How are safety-net hospitals faring in the current economic environment and how are they altering the way they provide care? How are states and safety-net systems…

  • Healthy San Francisco

    Fact Sheet

    In 2007, San Francisco became the first city in the nation to begin implementation of a plan to provide health care services to all uninsured residents. Healthy San Francisco is not health insurance, but rather it provides access to affordable basic and ongoing health care services for uninsured residents. The program provides medical homes to uninsured adults and focuses on prevention and the management of chronic conditions. Fact Sheet (.pdf)

  • Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA)

    Fact Sheet

    This fact sheet provides an overview of provisions of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), which was signed into law in February 2009. The Act extends and expands the State Children's Health Insurance Program (now referred to as CHIP, not SCHIP) that was enacted with bipartisan support a decade ago as part of the Balanced Budget Act of 1997 (BBA). Fact Sheet (.pdf) Fact Sheet: State Adoption of Coverage and Enrollment…

  • Rising Health Pressures in an Economic Recession: A 360-Degree Look at Four Communities

    Report

    This report draws on interviews and focus groups in four communities to examine at the grassroots levels the experiences of families, employers, safety-net providers and community organizations in four U.S. communities hard hit by the recession. The communities are Beloit, Wisc.; Tampa-St. Petersburg, Fla.; Long Island, N.Y.; and Sonoma, Calif. The report explores the financial and personal struggles of families who have suffered economic reversals and lost health coverage, forcing many to juggle bills and…

  • Better Care & Lower Costs: Exploring the Promise of Patient Engagement

    Event Date:
    Event

    03/05/10 Engaging consumers more directly in their care may improve health outcomes and help control the costs of care. This briefing, cosponsored by the Alliance for Health Reform and the AARP Public Policy Institute, focused on the potential for changing consumer behavior to promote the use of effective interventions and discourage unnecessary care. It addressed questions such as: How promising are consumer engagement techniques such as patient self-management, shared decision-making and value-based insurance design? What…

  • What’s in There? An Ask-the-Experts Overview of the Health Reform Law

    Event Date:
    Event

    The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 are now law. But many people have questions about the new reforms. To answer questions about the major provisions of these two laws, the Alliance for Health Reform and The Commonwealth Fund sponsored an April 16 briefing. For more information, please visit Alliance's event page. Full Video   Speakers for this session: The panel is co-moderated by Karen…