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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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  • Understanding Health Insurance

    Video

    The YouToons help consumers understand health insurance by explaining health insurance premiums, out-of-pocket costs, and provider networks. These three videos are excerpts from the 2014 YouToons video, Health Insurance Explained – The YouToons Have It Covered.

  • Trends in Employer-Sponsored Insurance Offer and Coverage Rates, 1999-2014

    Issue Brief

    This issue brief uses data from the National Health Interview Survey (NHIS) to examine trends in employer-sponsored health insurance (ESI) for different of individuals and households in the United States. While ESI remains the leading source of coverage for nonelderly people, the percentage covered by an employer plan has declined over the past 15 years. A similar pattern exists with firm offer rates; fewer workers were offered health insurance from their employer in 2014 than…

  • Pulling It Together: What Do We Want Health Insurance To Be?

    Perspective

    Trends in the health insurance marketplace show substantial growth in high deductible health plans, especially among smaller firms, where 35% of workers are now covered by plans with a deductible of $1,000 or more. That's according to our recently released employer health benefits survey, which we have been conducting now for ten years. The majority of these plans are simply high deductible health plans; only a minority are so-called "consumer driven" plans with savings accounts.…

  • Trends in Access to Care Among Working-Age Adults, 1997-2006

    Issue Brief

    Trends in Access to Care Among Working-Age Adults, 1997-2006 This policy brief finds about 39 million working-age adults nationally reported cost as a barrier to receiving needed health care in 2006, a number that grew by an average of 1 million people annually over the decade studied. Uninsured working-aged adults experienced the most consistent erosion over the 10 years, resulting in a widening gap in access to care between insured and uninsured adults. Policy Brief…

  • The COBRA Subsidy and Health Insurance for the Unemployed

    Issue Brief

    With the nation's unemployment rate rising to its highest levels in decades as a result of the recession, many families have lost their employer-sponsored health coverage or are at risk of doing so. In an effort to help people maintain coverage after a layoff, the stimulus legislation known as the American Recovery and Reinvestment Act of 2009 provides temporary subsidies to some workers so that they can maintain their previous employer-sponsored coverage through COBRA after…

  • Community Health Centers in an Era of Health System Reform and Economic Downturn: Prospects and Challenges

    Issue Brief

    This issue brief reviews the role of community health centers in the nation's health care safety net. The centers provided comprehensive primary care to 16.1 million patients in 2007, many of them from lower-income families and medically underserved communities. The role of the centers is even more critical during an economic recession when families are more vulnerable to economic loss and unmet health needs. Issue Brief (.pdf)

  • Explaining Health Reform: Questions About the Temporary High-Risk Pool

    Issue Brief

    The health reform law creates a temporary national high-risk pool to provide health coverage to people with pre-existing medical conditions who have been uninsured for six months. It is a temporary measure designed to bridge the gap until the implementation of other coverage provisions in the law that will take effect in January 2014. This summary provides answers to basic questions about the high-risk pool program. Brief (.pdf)

  • Expanding Medicaid to Low-Income Childless Adults Under Health Reform: Key Lessons From State Experiences

    Issue Brief

    The health reform law will expand Medicaid to millions of low-income adults, including many childless adults who have historically been ineligible for the program, necessitating one of the largest enrollment efforts in the program's history. This report, based on interviews with officials in seven states and the District of Columbia and national experts, examines lessons learned from past state experience covering childless adults through waiver and state-funded programs and profiles the programs included in the…

  • Public Reporting of Quality Outcomes: What’s the Best Path Forward?

    Event Date:
    Event

    The Affordable Care Act aims to promote higher quality care in part by rewarding – and eventually requiring – the reporting of certain quality measures. Previous efforts suggest that public reporting can add significant value. Yet there are concerns about the best way to measure outcomes and quality, the possible unintended effects of public reporting, and whether purchasers and consumers actually use the information to make choices. Panelists at this April 27 briefing co-sponsored by…