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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

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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  • Health Coverage and Care in the South: A Chartbook

    Report

    The South has faced longstanding disparities in health and health care, although significant variation exists between southern states. As a group, compared to those in other regions, Southerners are more likely to be uninsured, less likely to have access to needed health services, and more likely to experience a number of chronic health conditions. This chartbook provides key data on the demographic and economic characteristics of the southern population as well as their health status,…

  • Visualizing Health Policy: Preventive Services for Women and the ACA

    Other Post

    This month’s Visualizing Health Policy infographic takes a look at preventive health services for women, including missed opportunities for preventive counseling on risk factors (such as smoking or alcohol) and sexual health issues (such as contraception, sexually transmitted infections, and domestic violence), the effects of lack of insurance on rates of mammograms and other screening tests for women, and how costs are a barrier that cause some women to postpone preventive services or skip a…

  • Enrollment Surge Did Not Change Public’s Views on the Affordable Care Act

    News Release

    Most Common Reason for Remaining Uninsured is Not Being Able to Find an Affordable Plan; Just 7 Percent Would Rather Pay a Fine than Pay for Coverage As the Supreme Court Considers Challenge, a Majority Supports the Law's Requirements for Contraceptive Coverage, Including for Employers with Religious Objections Despite the news that 8 million people have signed up for health insurance through the ACA’s new marketplace, the April Kaiser Health Tracking Poll finds no change…

  • Medicare Advantage: Take Another Look

    Perspective

    This Policy Insight explores possible explanations for the continued rise in Medicare Advantage enrollment between 2010 and 2013 in spite of a projected decrease following payment changes in the Affordable Care Act (ACA).

  • The Next Big Health-Care Issue

    From Drew Altman

    Drew Altman, in The Wall Street Journal‘s Think Tank, writes that the next big concern for the Affordable Care Act (ACA) will be how much premiums increase in exchanges for 2015. He discusses the factors to focus on to put this issue in perspective when states report premium increases.

  • Visualizing Health Policy: Preventive Services for Women and the Affordable Care Act

    News Release

    This month’s Visualizing Health Policy infographic takes a look at preventive health services for women, including missed opportunities for preventive counseling on risk factors (such as smoking or alcohol) and sexual health issues (such as contraception, sexually transmitted infections, and domestic violence), the effects of lack of insurance on rates of mammograms and other screening tests for women, and how costs are a barrier that cause some women to postpone preventive services or skip a…

  • Medicaid Health Homes: A Profile of Newer Programs

    Issue Brief

    Under the ACA, states have a new Medicaid option to establish "health homes" designed to improve care coordination and integration and reduce costs for beneficiaries with chronic conditions. Thus far, 15 states have implemented health home programs. Following on a 2012 brief profiling Medicaid health home programs in the first six states to adopt the option, this brief describes the health home programs in the nine states that have implemented them since that time, and…

  • Where are California’s Uninsured Now? Wave 2 of the Kaiser Family Foundation California Longitudinal Panel Survey

    Report

    This second wave of the Kaiser Family Foundation's California uninsured survey assesses the impact of the Affordable Care Act to date on state residents who were uninsured prior to open enrollment. The results capture the share of previously uninsured Californians who gained coverage or remained uninsured, how they feel about and interact with their new coverage options and what barriers to getting insurance remain. The report examines breakouts by race, coverage type, and other demographic…

  • Survey Finds Approximately 3.4 Million Previously Uninsured Adult Californians Obtained Coverage Since Start of the Affordable Care Act’s First Open Enrollment Period

    News Release

    Immigration Status and Fears Pose Challenges to Further Expanding Coverage Among Hispanics Affordability Key Obstacle to Enrollment for Those Who Remain Uninsured MENLO PARK, Calif. -- Nearly six in 10 (58%) previously uninsured Californians report getting health insurance since last summer, finds the second wave of the Kaiser Family Foundation's Longitudinal Panel Survey following the experiences of a randomly selected  panel of uninsured Californians under the Affordable Care Act (ACA). Based on official estimates of…