Affordable Care Act

The ACA Marketplace

2025 KFF Marketplace Enrollees Survey

In 2025, about one in three ACA enrollees said they would be “very likely” to look for a lower-premium Marketplace plan If their premium payments doubled.

Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees

Following the expiration of the enhanced premium tax credits for people with Affordable Care Act (ACA) Marketplace plans, a new KFF follow-up survey of the same Marketplace enrollees KFF surveyed in 2025 finds half (51%) of returning enrollees say their health care costs are “a lot higher” this year compared to last year, including four in 10 who specifically say their premiums are “a lot higher.”

Timely insights and analysis from KFF staff

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

    Fact Sheet

    This state report explains how the ACA expands coverage in South Dakota, 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 South Dakota are eligible for Medicaid or financial assistance in the Marketplace. For states not expanding Medicaid, the report quantifies how many uninsured people fall into the “coverage gap,” meaning they will be ineligible for financial assistance in the Marketplace or for Medicaid in their state despite having an income below the federal poverty level.

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Utah, 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 Utah are eligible for Medicaid or financial assistance in the Marketplace. For states not expanding Medicaid, the report quantifies how many uninsured people fall into the “coverage gap,” meaning they will be ineligible for financial assistance in the Marketplace or for Medicaid in their state despite having an income below the federal poverty level.

  • 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 the Marketplace. For states not expanding Medicaid, the report quantifies how many uninsured people fall into the “coverage gap,” meaning they will be ineligible for financial assistance in the Marketplace or for Medicaid in their state despite having an income below the federal poverty level.

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Wisconsin, 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 Wisconsin are eligible for Medicaid or financial assistance in the Marketplace. For states not expanding Medicaid, the report quantifies how many uninsured people fall into the “coverage gap,” meaning they will be ineligible for financial assistance in the Marketplace or for Medicaid in their state despite having an income below the federal poverty level.

  • Data Note: How Many People Have Nongroup Health Insurance?

    Issue Brief

    The implementation of the Affordable Care Act (ACA) has focused attention on the composition of the nongroup market: how it looked before the new regulatory provisions take effect and how it will change afterwards. There are several ways of answering this question, depending on the time period for measuring enrollment and the information source. There is substantial turnover among people with nongroup coverage, which means that the number of people covered at the beginning of a year (or at any other point in time) is quite different than the number of people who keep that coverage throughout the whole year.

  • Managing a High Performing Medicaid Program

    Report

    This report discusses key responsibilities that the federal government and states hold for managing the Medicaid program and identifies the key issues and challenges states face as they transform the way they do business and achieve key national goals. The paper relies on an extensive review of federal and state administrative responsibilities drawn from statute, regulation, and relevant literature, coupled with discussions with six current Medicaid directors.

  • Getting into Gear for 2014: Insights from Three States Leading the Way in Preparing for Outreach and Enrollment in the Affordable Care Act

    Issue Brief

    This report provides insight into preparations in Maryland, Nevada, and Oregon -three states that have established a State-based Marketplace, are moving forward with the Medicaid expansion, and are among the states leading the way in preparing for outreach and enrollment. e findings provide an overview of where these three states are in establishing their Marketplaces; preparing for the Medicaid expansion; planning for marketing, outreach and enrollment; and establishing enrollment assistance resources. It highlights the challenges the states have encountered and overcome, the successes they have achieved, and provides key lessons that may help inform implementation efforts moving forward.

  • Providing Outreach and Enrollment Assistance: Lessons Learned from Community Health Centers in Massachusetts

    Issue Brief

    As states and communities gear up to provide outreach and enrollment assistance under the ACA, the enrollment assistance experience of health centers in Massachusetts, where a major expansion of health coverage was implemented six years ago, offers valuable lessons that can help to inform current and emerging efforts by health centers and other community-based organizations to reach and enroll millions of low-income, uninsured Americans in health insurance.

  • Getting into Gear for 2014: An Early Look at Branding and Marketing of New Health Insurance Marketplaces

    Issue Brief

    Based on a review of publicly available materials as of September 2013, this brief provides an examination of the Marketplace branding strategies, websites, and marketing materials, providing insight into how consumers will be introduced to the Marketplaces and some of the key messages and approaches the Marketplaces will utilize to encourage individuals to enroll. As of September 2013, states and the federal government are on the eve of their October 1st launch of open enrollment for the new Health Insurance Marketplaces, where consumers will be able to shop for and purchase private coverage and potentially receive subsidies to lower the cost of that coverage. Achieving adequate enrollment through these Marketplaces will be important for fulfilling the Affordable Care Act’s (ACA’s) goal of reducing the nation’s uninsured rate. Moreover, sufficient enrollment, particularly among younger and healthy individuals, will be important for ensuring the financial sustainability of the Marketplaces over time. Recognizing the importance of enrollment, the federal government and the 17 states operating State-based Marketplaces have invested resources and conducted extensive consumer research to inform the branding and marketing campaigns for their Marketplaces.