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 Michigan Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Michigan, 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 Michigan are eligible for Medicaid or financial assistance in…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Nevada, 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 Nevada are eligible for Medicaid or financial assistance in…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in New York, 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 New York are eligible for Medicaid or financial…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Florida, 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 Florida are eligible for Medicaid or financial assistance in…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Colorado, 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 Colorado are eligible for Medicaid or financial assistance in…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Missouri, 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 Missouri are eligible for Medicaid or financial assistance in…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Texas, 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 Texas are eligible for Medicaid or financial assistance in…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Illinois, 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 Illinois are eligible for Medicaid or financial assistance in…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Maryland, 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 Maryland are eligible for Medicaid or financial assistance in…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in 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 Virginia are eligible for Medicaid or financial assistance in…