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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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  • Premiums Set to Decline Slightly for Benchmark ACA Marketplace Insurance Plans in 2015

    News Release

    Analysis of 15 States and D.C. Also Finds Changes Vary Across States and Insurers Results Suggest Consumers Should Shop Carefully When Open Enrollment Begins November 15 MENLO PARK, Calif. -- An early look at the cost of health insurance in 16 major cities finds that average premiums for the benchmark silver plan – the one upon which federal financial help under the Affordable Care Act to consumers is based – will decrease slightly in 2015. …

  • Voters In Competitive Senate States Report Seeing More ACA Ads, Especially Ads Opposed To The Law

    Kaiser Health Tracking Poll: August-September 2014

    Feature

    The latest Kaiser Health Tracking Poll includes a special look at registered voters’ views and what role, if any, the the Affordable Care Act might be playing in the upcoming midterm election. Partisan divisions on the law are as deep as ever, not only when it comes to overall opinion but also in the public’s perception of how the law has impacted their own families and the next steps they want Congress to take.

  • Republicans Have an Edge in Voter Enthusiasm Heading Into Fall, But Few Cite ACA as Motivating Factor

    News Release

    Anti-Obamacare Ads Reaching Most Voters in Competitive Senate Races Health Care Ranks Among Several Second-Tier Issues for Voters in Midterm Elections Behind the Economy The latest Kaiser Family Foundation Health Tracking Poll finds Republicans with a modest edge in terms of voter enthusiasm, but the Affordable Care Act, also called Obamacare, is not the main motivator. The poll finds that 27 percent of Republicans say they are “more enthusiastic” about voting this year than in…

  •  In Employer Health Insurance Costs, Stability Is The New Normal

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman looks at the sharply slower growth in premiums for employer health benefits and what it might mean for the future of employer-sponsored coverage. All previous columns by Drew Altman are available online.

  • Low-Wage Workers Feel the Pinch on Health Insurance

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman explores how low-wage firms and their workers are faring in the employer-based health insurance market and how the Affordable Care Act may influence future trends.

  • Understanding How States Access the ACA Enhanced Medicaid Match Rates

    Issue Brief

    This brief reviews the rules around the enhanced federal medical assistance percentages (FMAP) provided in the Affordable Care Act (ACA), the process for states to claim the enhanced matching funds and a discussion about what information the new data will provide looking forward.

  • Uncompensated Care for the Uninsured in 2013: A Detailed Examination

    Report

    This report provides estimates of spending for uncompensated care, in 2013, just before implementation of health reform’s major coverage provisions. The report estimates the amount of uncompensated care provided, analyzes the site of care for uncompensated services, and details sources of funding for uncompensated care. These estimates provide an important baseline against which to measure major changes that are occurring under the ACA.

  • The Affordable Care Act and Insurance Coverage in Rural Areas

    Issue Brief

    Rural populations face disparities compared to metropolitan populations in health care. While rural individuals were not more likely to be uninsured than metropolitan counterparts pre-Affordable Care Act, they were poorer and less likely to have private insurance. With coverage changes in the ACA involving an expansion of Medicaid for poor and near-poor populations, decisions by states with large rural populations may cause rural residents to have disparate access to coverage, which may exacerbate cost and…

  • Medicaid Enrollment Snapshot: December 2013

    Issue Brief

    This report focuses on changes in monthly Medicaid enrollment between December 2012 and December 2013. This is a long standing report series that collects monthly Medicaid enrollment data for December (and June, not reported here) going back to 2000. While the most recent data included in this report predate preliminary data released by CMS that show the early effects of full implementation of the ACA, this report series is an important source of historical trend…

  • Strategies in 4 Safety-Net Hospitals to Adapt to the ACA

    Issue Brief

    This brief examines four safety-net hospitals to learn how they were preparing for the full implementation of the Affordable Care Act (ACA), in order to gain additional insight into the strategies being used and challenges being faced among safety-net hospitals across the country.