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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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  • KFF Data Note: Americans’ Views on the Personal Impact of the ACA and the Supreme Court’s Decision

    Perspective

    As the Supreme Court hears cases challenging the constitutionality of parts of the Affordable Care Act, a relatively small share of the public thinks the Supreme Court’s decision will have a lot of impact on their family (28 percent). At the same time, the public is divided as to whether the law overall will leave their own families better off (26 percent), worse off (33 percent), or if it won’t make much difference (34 percent).…

  • KFF Data Note: A Snapshot of Public Opinion on the Individual Mandate

    Perspective

    This week, the Supreme Court hears arguments on several challenges to the Patient Protection and Affordable Care Act (ACA), including the provision that requires individuals to purchase health insurance as of 2014, known as the individual mandate. For the two years since the law’s passage, and during the debate leading up to it, this provision has been one of the most controversial aspects of the law. As the lawyers, policymakers, ACA opponents and supporters focus…

  • Health Insurance Transparency under the Affordable Care Act

    Perspective

    In February, a final rule was issued implementing the Affordable Care Act (ACA) requirement that all health plans provide a uniform summary of coverage for all enrollees and applicants. The idea of providing easy-to-understand summaries of coverage is, in fact, the most popular provision in the ACA, according to a recent Kaiser tracking poll. That finding suggests powerful consumer frustration over the complexity of health insurance and the difficulty people face evaluating health insurance choices and understanding…

  • Public Opinion on the ACA: Cruising or Turbulent Ride?

    Perspective

    Regular readers of the Kaiser Health Tracking poll know by now that public opinion on the Affordable Care Act (ACA) has been at a steady cruising altitude since it was signed into law on March 23, 2010, with a little over four in ten viewing the law favorably and a similar share unfavorably. But, has public opinion on the law since passage been more turbulent for different groups of Americans, for example, those with lower…

  • How the ACA Changes Pathways to Insurance Coverage for People with HIV

    Perspective

    There are multiple sources of insurance coverage and care for people with HIV in the United States.  These include public programs, such as Medicaid and Medicare, and the Ryan White HIV/AIDS program, as well as private coverage through an employer or in the individual market. Medicaid, the nation's principal safety-net health insurance program for low-income Americans, is estimated to cover the largest share of people with HIV. Fewer are covered by Medicare, the federal health…

  • How Small Business Owners Get Health Insurance

    Perspective

    As with any economic policy issue, there has been much discussion of how the Affordable Care Act (ACA) will affect small businesses. But, there’s been very little focus on how the health reform law will affect the owners of those businesses as people. As our recently released Employer Health Benefits Survey shows, small businesses are much less likely than larger businesses to offer health benefits to their workers. Half of businesses with 3-9 workers and…

  • Key Findings from the Field: Early Experience with ACA Enrollment in Maryland and Nevada

    Issue Brief

    To learn more about the early ACA enrollment experience in two states, the Kaiser Commission on Medicaid and the Uninsured and PerryUndem Research and Communication conducted focus groups in Baltimore, Maryland and Reno, Nevada in November 2013 with low- and moderate-income individuals who recently applied for health insurance and consumer assisters trained to help individuals enroll. This study builds on previous work that examined preparations for open enrollment in several states, including Maryland and Nevada,…

  • Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors

    Issue Brief

    This brief explains three provisions of the Affordable Care Act (ACA) – risk adjustment, reinsurance, and risk corridors – that were intended to promote insurer competition on the basis of quality and value and promote insurance market stability, particularly in the early years of reform as the ACA marketplaces, also known as exchanges, were established.

  • Webinar for Journalists: Women’s Health Under the Affordable Care Act

    Event Date:
    Event

    The Kaiser Family Foundation hosted an interactive webinar for journalists through its Media Fellowships Program: "Women's Health Under the Affordable Care Act," which took place on Thursday, February 6 from 12:30 p.m. to 1:30 p.m. ET. Now that the ACA's coverage expansions are in effect, the Foundation's latest webinar looked at how the law affects women's access to health coverage and care. The Kaiser Family Foundation's Alina Salganicoff, Vice President and Director of Women's Health Policy, and…

  • Medicaid Enrollment: June 2013 Data Snapshot

    Issue Brief

    This Data Snapshot provides 50-state data on Medicaid monthly enrollment trends, adding June 2013 data. Overall, Medicaid enrollment growth continued to slow to the lowest rate since the start of the Great Recession as the economic conditions continued to slowly improve. While enrollment growth rates have been trending downward as economic conditions continue to slowly improve, enrollment growth is expected to increase significantly as states implement the ACA. Regardless of whether states decide to implement…