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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

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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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  • Reaching for the Stars: Quality Ratings of Medicare Advantage Plans, 2011

    Issue Brief

    New: Medicare Advantage Plan Star Ratings and Bonus Payments in 2012 In 2012, Medicare Advantage plans will be awarded additional payments based on their quality ratings as a result of the 2010 health reform law. The Centers for Medicare and Medicaid Services has proposed a demonstration that would modify the quality-based payments for plans, providing additional payments for 2012 to 2014. This policy brief by the Kaiser Family Foundation examines the quality ratings of private…

  • Strengthening Medicaid with Health Information Technology: Are Providers & States Up to the Challenge?

    Event Date:
    Event

    Health care providers can receive Medicare and Medicaid payment incentives when they adopt electronic health records and demonstrate their "meaningful use." Additionally, states must establish a website by 2014 for Medicaid beneficiaries to electronically enroll and renew coverage. Yet many challenges remain so that health information technology (HIT) can help the Medicaid program operate more effectively. How can Medicaid health plans and providers use HIT to provide better care delivery and improve health outcomes while…

  • Briefing, Survey Examine 2012 Data From 50-State Survey of Medicaid and CHIP Eligibility and Enrollment Policies

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    Event

    Despite continued tight state budgets, a requirement in the Affordable Care Act (ACA) that states maintain eligibility in Medicaid and Children’s Health Insurance Programs was central in preserving coverage during 2011. In addition, more than half of states (29) made improvements in their programs, often using technology to increase program efficiency and streamline enrollment. These and other findings appear in the Kaiser Commission on Medicaid and the Uninsured report, "Performing Under Pressure: Annual Findings of…

  • Who Will be the H&R Block and TurboTax for Health Insurance?

    Perspective

    There's been quite a bit of focus lately insofar as these issues go, anyway on health insurance agents and brokers (sometimes known in the industry as "producers"). They are pushing legislation that has been introduced in Congress and is now being studied by the National Association of Insurance Commissioners that would exempt agent and broker commissions for health insurance from minimum medical loss ratio (MLR) thresholds established in the health reform law. (The MLR is…

  • Measuring the Affordability of Employer Health Coverage

    Perspective

    A recent draft regulation issued by the Treasury Department describes who is eligible for premium tax credits to help them afford coverage offered through health insurance exchanges beginning in 2014. Tax credits will be available to people with incomes between 100 and 400 percent of the poverty level who are not eligible for public coverage such as Medicaid or Medicare and who are not offered affordable health coverage by an employer. The approach that the…

  • KFF/Harvard Survey on Public’s Health Care Agenda for the 112th Congress Finds An Uptick in Public Opposition to Health Reform As GOP Ramped Up Repeal Campaign

    Perspective

    Though the public remains divided on health reform overall, according to a new survey jointly conducted by the Kaiser Family Foundation and Harvard School of Public Health, opposition to the new law ticked upward in January from 41 percent to 50 percent as Republicans ramped up efforts to repeal it. The survey also showed that there is no groundswell of public support for overturning the law, with 47 percent wanting to either expand the law…

  • What is a Mini-Med Plan?

    Perspective

    One of the early insurance market changes in the Affordable Care Act (ACA) phases out caps that some insurance plans impose on the annual dollar amount of benefits they will cover. Plans issued or renewed after September 23, 2010 cannot have annual limits of less than $750,000, and the threshold goes up to $1.25 million in 2011. Annual dollar limits of any kind are prohibited starting in 2014. The federal government has issued waivers from…

  • Health Affairs Issue Focuses on Health Reform

    Perspective

    The June 2010 issue of the journal Health Affairs is dedicated to health reform, and "begins to tackle the hundreds of implementation issues inherent in health reform and offers prescriptions for averting trouble," according to Editor-in-Chief Susan Dentzer. The issue features an article by Kaiser researchers examining past and present polling related to reform and showing how a surprisingly stable public opinion tracked with historic patterns, even if the contentious public debate suggested a volatile…

  • Confusion Declines, but Remains Widespread in KFF May Tracking Poll

    Perspective

    Confusion over the new health reform law declined but remains widespread, with 44 percent of the public saying they were confused in May, compared to 55 percent in April. Moreover, more than a third of Americans (35%) say they do not understand what the impact of the law will be on themselves and their families, while 61 percent report feeling they do understand what that impact will be. Americans continue to report getting information about…

  • Private Insurance Benefits and Cost-Sharing Under the ACA

    Perspective

    The Department of Health and Human Services (HHS) recently released guidance on the two key components that determine the level of protection that private insurance plans will provide to consumers under health reform. The first involves the services that insurance plans must cover, and the second involves how much patients must pay out-of-pocket for those services. The Affordable Care Act (ACA) establishes new rules for what insurers must provide for both components starting in 2014.…