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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

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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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  • Abortion Coverage in Marketplace Plans, 2015

    Issue Brief

    This brief analyzes state policies and insurer coverage decisions affecting the availability of abortion coverage in 2015 insurance plans offered through the Marketplaces. It finds that abortion coverage is unavailable in a total of 31 states, 24 of which have enacted laws that ban or restrict abortion coverage in plans sold through their Marketplaces and 7 of which have no abortion coverage restrictions but also have no Marketplace plans offering it.

  • Adults who Remained Uninsured at the End of 2014

    Issue Brief

    This report, based on the 2014 Kaiser Survey of Low-Income Americans and the ACA, profiles the adult population that remained uninsured as of Fall 2014. It describes the characteristics of this population, examines why they lack insurance coverage and reasons for not enrolling in ACA coverage, and provides information on the coverage options available to the remaining uninsured and their plans for obtaining coverage in 2015.

  • Federal and State Standards for “Essential Community Providers” under the ACA and Implications for Women’s Health

    Issue Brief

    Safety net providers such as community health centers and family planning clinics have served a significant role in the provision of primary care and reproductive health care services to low-income and uninsured people, particularly women. The Affordable Care Act (ACA) has a provision aimed at assuring that newly-insured individuals, as well as those without coverage, can continue seeing their trusted safety net providers, also called Essential Community Providers (ECPs). This brief reviews the definition of…

  • Safety-Net Emergency Departments: A Look at Current Experiences and Challenges

    Issue Brief

    Safety-net hospital emergency departments (EDs) are an important part of our health care system, especially, but not only, for the uninsured and others with low income. With multiple major changes unfolding in our system today, including the development of new models of health care delivery, payment reforms, expanded insurance coverage, and increasing demand for primary care access, safety-net EDs are a sort of crucible in which these shifts and transitions can be seen playing out.…

  • Proposed Medicaid Expansion in Tennessee

    Fact Sheet

    This fact sheet describes Tennessee’s 1115 waiver demonstration project, Insure Tennessee, which expands the State’s Medicaid program under the Affordable Care Act.

  • The Cost of Care with Marketplace Coverage

    Issue Brief

    This brief and accompanying slides examine cost sharing - deductibles, copayments and coinsurance - in 2015 insurance plans sold on the Affordable Care Act's (ACA) federally-facilitated marketplaces. The analysis looks at out-of-pocket limits, as well as cost sharing for hospital stays, physician visits, emergency room visits, and prescription drugs, for plans across the metal levels (platinum, gold, silver and bronze).

  • Analysis Estimates 1 in 4 Employers Offering Health Benefits Could Be Affected by the ‘Cadillac Tax’ in 2018 if Current Trends Continue

    News Release

    Share of Potentially-Affected Employers Could Grow to 30% in 2023, 42% in 2028, Analysis Finds New projections from the Kaiser Family Foundation estimate that one in four employers (26%) offering health benefits could be subject to the Affordable Care Act’s tax on high-cost health plans, also known as the "Cadillac plan" tax, in 2018 unless they make changes to their plans. The analysis also estimates that the share of employers potentially affected by the tax…

  • The ‘Private Option’ Medicaid Expansion in Arkansas Has Helped Reduce the Uninsured Rate and Uncompensated Care Costs While Boosting the State’s ACA Marketplace

    News Release

    A new issue brief from the Kaiser Family Foundation finds that Arkansas’ “private option” Medicaid expansion has helped reduce the number of uninsured and bring down uncompensated care costs while strengthening the state’s ACA marketplace. A Look at the Private Option in Arkansas draws upon early data as well as interviews conducted in spring 2015 with state officials, providers, insurance carriers, and consumer advocates to provide an initial look how implementation of the private option…

  • Analysis of 2016 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces

    Fact Sheet

    The chart and tables below present an updated analysis of changes in premiums for the lowest- and second-lowest cost silver Affordable Care Act (ACA) marketplace plans in major cities in 48 states and the District of Columbia, where we were able to find complete data on rates for all insurers. This page will be updated as complete rate information becomes available for more states. More background can be found in our earlier analysis of 2016…