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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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  • States’ Participation in Six Key Medicaid Long-Term Services and Supports Options Provided or Enhanced by the Affordable Care Act

    Feature

    States’ Participation in Six Key Medicaid Long-Term Services and Supports Options Provided or Enhanced by the Affordable Care Act Download Source M. O’Malley Watts, M. Musumeci, and E. Reaves, How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports (LTSS) Today? State Adoption of Six LTSS Options, The Henry J. Kaiser Family Foundation, April 2013, available at: http://www.kff.org/medicaid/issue-brief/how-is-the-affordable-care-act-leading-to-changes-in-medicaid-long-term-services-and-supports-ltss-today-state-adoption-of-six-ltss-options/;  updates available at: http://www.kff.org/state-category/health-reform/.

  • State Marketplace Profiles: Oregon

    Other Post

    Final update made on October 10, 2013 (no further updates will be made)  Establishing the Marketplace On June 17, 2011, Governor John Kitzhaber (D) signed SB 99 into law establishing the Oregon Health Insurance Exchange Corporation.1   That same month, the Governor signed SB 91, which specified requirements of health insurance carriers offering coverage in the state.2  On March 6, 2012, the legislature passed HB 4164 to approve the final version of the Marketplace’s business plan.3 …

  • State Marketplace Profiles: Illinois

    Other Post

    Final update made on October 15, 2013 (no further updates will be made) Establishing the Marketplace While Governor Pat Quinn (D) had considered establishing a state-based marketplace via executive order, he began moving in the direction of a state-federal partnership marketplace in July 2012.1 ,2  While the state has established a Partnership Marketplace, the administration still intends to transition to a fully State-based Marketplace in 2015 and will continue with the necessary planning. Illinois will be…

  • State Marketplace Profiles: Arkansas

    Other Post

    Final update made on October 29, 2013 (no further updates will be made) Establishing the Marketplace On December 12, 2012, Governor Mike Beebe (D) informed federal officials that Arkansas would pursue a state-federal partnership health insurance Marketplace (also referred to as exchange).1  A state opting for a partnership Marketplace can choose to operate plan management functions, consumer assistance functions, or both. A state can also elect to perform Medicaid and Children’s Health Insurance Program (CHIP)…

  • 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.

  • Obamacare and You: If You Are Uninsured…

    Fact Sheet

    The Affordable Care Act, also called Obamacare, creates several new ways to get health coverage. This fact sheet explains how If you are uninsured and not offered health coverage through your job, you may be able to obtain coverage through Medicaid or through a new health insurance marketplace (or exchange) in your state. It is from our Obamacare & You series.