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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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  • 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

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    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…

  • Explaining Health Care Reform: Questions About the Extension of Dependent Coverage to Age 26

    Issue Brief

    The new health reform law requires private health insurers that offer dependent coverage to children to allow young adults up to age 26 to remain on their parent's insurance plan. This provision is among the first in the reform law to take effect, and it increases the availability of insurance to a population that currently has a high uninsured rate. This short summary answers basic questions about the dependent coverage expansion and explains how the…

  • What’s in There? The New Health Reform Law and Private Insurance

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    Event

    This briefing focuses on how the reform law affects access to private coverage, including the new federal high-risk pools, tax credits for small businesses, health insurance exchanges, the individual mandate and employer obligations. This briefing, cosponsored by the Alliance for Health Reform and the Kaiser Family Foundation, explored these and other issues. For more information, please visit Alliance's event page. Full Video    Speakers for this session: The panel is co-moderated by Diane Rowland of…

  • Community Health Centers in an Era of Health Reform: An Overview and Key Challenges to Health Center Growth

    Issue Brief

    Over 1,100 federally funded community health centers play a vital role in ensuring access to health care for a predominantly low-income population in medically underserved communities. Health centers’ ability to provide comprehensive primary care and improve access to high-quality care while holding down health care cost growth has been well-documented. As health reform spurs coverage expansion and efforts to improve quality, the nation’s reliance on health centers is likely to grow. In the Affordable Care…

  • Report and Video Highlight Health Coverage Struggles, Other Economic Concerns of Working Families

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    Event

    This report and video from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU) illustrate the financial struggles of many families in the United States and show the central role of health care costs and coverage in a household's economic stability. The report, Snapshots from the Kitchen Table: Family Budgets and Health Care, is based on interviews with 27 families from six cities across the U.S.. It finds pervasive uncertainty over job security…

  • Pulling It Together: Predictions

    Perspective

    I usually don’t make predictions, unless they are backed up by the kind of statistical modeling we often produce.  But here are three predictions I am confident about that form the basis of this latest column. GROUP HEALTH INSURANCE PREMIUMS WILL CONTINUE TO RISE AT HISTORICALLY MODERATE LEVELS, AT LEAST FOR THE NEXT FEW YEARS.  One reason for this is the lingering effect of the recession.  Employers will have little trouble attracting workers in the…

  • Explaining Health Reform: The New Rules for Determining Income Under Medicaid in 2014

    Issue Brief

    To provide individuals and families access to affordable, high-quality health care, the Patient Protection and Affordable Care Act (ACA) expands Medicaid to cover low-income adults and children with incomes up to 133 percent of the poverty line. Millions of low-income parents, non-disabled adults who do not have dependent children (and who are generally ineligible for Medicaid today except in a small number of states) and, in some instances, children now covered through the Children’s Health…

  • Pulling It Together: Changing the HIV Testing Message

    Perspective

    In 2006 the CDC began recommending routine HIV testing in health care settings for everyone between the ages of 13 and 64. Annual  testing is recommended for people at highest risk. Our 2011 survey of Americans and HIV released last week -- our eighth comprehensive survey of its kind --  shows that more people are talking with their doctors about being tested for HIV, but that reported rates of actually getting tested have remained virtually…