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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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  • Web Briefing: The California v. Texas Supreme Court Case and Its Implications for the ACA

    Event Date:
    Event

    On Tuesday, Nov. 10, the Supreme Court will hear oral arguments on a legal challenge supported by the Trump administration that seeks to overturn the Affordable Care Act, an outcome that would have major effects throughout the health care system as the law’s provisions have affected nearly all Americans in some way. KFF held an interactive web briefing on Monday, Nov. 9, to share insights about the legal issues in the case and the potential…

  • Poll: Nearly Half of the Public Say They or a Family Member Skipped or Delayed Care Due to Coronavirus, But Most Plan to Get Care in the Coming Months

    News Release

    Nearly One in Four Expect a Family Member to Turn to Medicaid in the Coming Year, and Majorities across Party Lines Oppose Medicaid Cuts to Address State Budget Shortfalls Amid the threat of coronavirus, nearly half (48%) of Americans say someone in their family has skipped or delayed getting some type of medical care due to the pandemic, the latest KFF Health Tracking Poll finds. This includes 11% who say the person’s condition worsened due…

  • Election 2020: Where Trump and Biden Stand on Mental Health and Substance Use Issues

    News Release

    Amid the coronavirus pandemic, half of Americans report that their mental health has been negatively impacted due to related stress and worry. Many are, or will be, struggling with mental health challenges due to anxiety, social isolation, loss of loved ones, and job losses – potentially leading to increased mental health care needs over the long term. A new issue brief examines where President Trump and Democratic presidential nominee Joe Biden stand on key aspects of the…

  • JAMA Forum: Trump vs Biden on Health Care

    Perspective

    In this September 2020 post for The JAMA Health Forum, Larry Levitt highlights differences in the records and policy plans of President Donald Trump and former Vice President Joe Biden on key health care issues.

  • President Trump’s Record on Health Care

    Issue Brief

    This issue brief provides a detailed overview of the Trump Administration’s record on health care issues relating to: the Administration’s response to the COVID-19 pandemic, the ACA and private insurance markets, Medicaid, Medicare, reducing prescription drug and other health care costs, sexual and reproductive health, mental health and substance use, immigration and health, long-term care, HIV/AIDS policy, and LGBTQ health.

  • From the Federal Response to COVID-19 to Ongoing Efforts to Repeal the ACA and Proposals for Lowering Drug Prices, President Trump Has an Extensive Record on Health Care

    News Release

    Since taking office in 2017, President Trump has laid down an extensive record on health care, including his response to the COVID-19 pandemic, his early and ongoing efforts to repeal and replace the Affordable Care Act, his annual budget proposals to curb spending on Medicare and Medicaid, his executive orders and other proposals to lower prescription drug prices, and his initiative on hospital price transparency. President Trump’s record on health care provides a window into…

  • What Will Candidates Say About Medicare This Election?

    Perspective

    In this article for the American Society of Aging’s Generations Today, KFF Senior Vice President Tricia Neuman examines what President Trump and former Vice President Joe Biden are saying about key issues for Medicare beneficiaries, including drug prices and affordability, as well as what they aren’t saying about Medicare’s financing.