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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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  • Quality Ratings of Medicare Advantage Plans: Key Changes in the Health Reform Law and 2010 Enrollment Data

    Issue Brief

    NEW: Foundation brief looks at implications of 2011 quality ratings for Medicare Advantage plans. This Kaiser Family Foundation issue brief examines the key changes in this year’s health reform law that will reward bonuses to private Medicare Advantage plans based on quality rating. Medicare currently rates plans on a five-star scale, with five stars representing the highest quality. The brief analyzes plans based on their quality rating for the current year and also examines enrollment…

  • Briefing Examines High Medicare Spending for Beneficiaries in Long-Term Care

    Event Date:
    Event

    These three reports examine the relatively high use of hospital and other Medicare-covered services and the associated costs of medical care for Medicare beneficiaries who live in nursing homes and other long-term-care facilities. They also explore the potential for delivery system reforms to improve quality and reduce costs. Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long-Term Care Facilities: A Potential for Achieving Medicare Savings and Improving the Quality…

  • Five Key Questions And Answers About Section 1115 Medicaid Waivers

    Issue Brief

    This issue brief provides an overview of what Section 1115 Medicaid waivers are, how they are approved and financed, how states have used them, and how they are impacted by health reform. For many years, Section 1115 waivers have been used by states to test new coverage approaches not otherwise allowed under Medicaid program rules. Some waivers have also raised important policy issues. Since the passage of the health reform law, several states, including California,…

  • Family Health Premiums Rise 4 Percent to Average of $15,745 in 2012, National Benchmark Employer Survey Finds

    News Release

    Menlo Park, Calif. – Annual premiums for employer-sponsored family health coverage reached $15,745 this year, up 4 percent from last year, with workers on average paying $4,316 toward the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2012 Employer Health Benefits Survey released today. This year’s premium increase is moderate by historical standards, but outpaced the growth in workers’ wages (1.7 percent) and general inflation (2.3 percent). Since…

  • La reforma del cuidado de salud llega al público

    Video

    ¿Esta confundido acerca de cómo la nueva ley de reforma de salud realmente funciona? Este video explica los problemas relacionados con el sistema de salud actual, los cambios que están sucediendo ahora, y los cambios importantes que se anticipan para el 2014.

  • Compare Proposals to Replace The Affordable Care Act

    Interactive

    President Donald Trump and Republicans in Congress have committed to repealing and replacing the Affordable Care Act (ACA). How do their replacement proposals compare to the ACA? How do they compare to each other? Includes the Graham-Cassidy-Heller-Johnson amendment (introduced 9/13/2017) as well as other proposals from key members of Congress.

  • The Republican Health-care Plan the Country Isn’t Debating

    From Drew Altman

    In this Washington Post op-ed, Drew Altman discusses how Republicans' ideas to change Medicaid and Medicare and repeal the Affordable Care Act would fundamentally change the federal role in health, calling it: the biggest change in health we are NOT debating.

  • Key Issues in Children’s Health Coverage

    Issue Brief

    This brief reviews children’s coverage today and examines what is at stake for children’s coverage in upcoming debates around CHIP funding, repeal and replacement of the ACA, and Medicaid restructuring.

  • ACA Medicaid Expansion Drove Nationwide Increase in Health Coverage for People with HIV, First National Analysis Finds

    News Release

    As Congress moves to repeal the Affordable Care Act, a new analysis from the Kaiser Family Foundation provides the first national estimates of changes in health coverage for people with HIV since the law was implemented. It finds that rolling back the law’s Medicaid expansion could significantly impact coverage for people with HIV. Nationwide, Medicaid coverage for people with HIV in care rose six percentage points between 2012 to 2014, when ACA coverage expansions took…