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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

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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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  • Best Bets for Reducing Medicare Costs for Dual Eligible Beneficiaries: Assessing the Evidence

    Report

    With pressure mounting to slow the growth in federal health care spending, policymakers are exploring ways to reform the way care is delivered to the 9 million low-income Medicare beneficiaries who also receive Medicaid – a group that on average is sicker and frailer than other Medicare beneficiaries, and therefore receive significantly more care at greater cost. Major efforts are underway at the federal and state level to better coordinate care for this population and…

  • KFF June Tracking Poll Finds Health Care in the November 2010 Mix

    Perspective

    The start of summer finds Americans remain divided on the health reform law, but favorable views of the new law increased seven percentage points over the past month to 48 percent, compared to 41 percent who have “generally unfavorable” views and 10 percent who have yet to make up their minds, according to the Kaiser Family Foundation’s newly released June Health Tracking Poll. With four months remaining until the midterm congressional elections, an early look…

  • New Tracking Poll Finds Americans Remain Divided Over Health Law

    Perspective

    With the November midterm elections just weeks away, Americans remain chronically divided over the Patient Protection and Affordable Care Act, but most say that their feelings – pro and con -- about the health reform law are not a dominant factor in how they will vote for Congress or whether they will go to the polls, according to the new Kaiser Health Tracking Poll. Views on health reform tightened up in October, with 42 percent…

  • Pulling it Together: Separating the Forest from the Trees in the Health Reform Debate

    Perspective

    The good news for those who care about health care is that the issue is rising again on the national agenda. If we have a big debate about health in the presidential campaign and if it is a factor at the polls in 2008, it will help create a mandate for the new president and Congress to make health care a priority in 2009. But the real health care debate has been delayed by the…

  • Health Insurance Coverage for Older Adults: Implications of a Medicare Buy-In

    Issue Brief

    As the Senate debates comprehensive health reform legislation, the idea of a Medicare buy-in option for uninsured adults aged 55-64 has re-emerged as a potential component of a reform plan. This Kaiser Family Foundation policy brief provides an updated profile of the more than 4 million uninsured people between ages 55 and 64 and examines historical proposals to allow uninsured older adults to purchase Medicare coverage. It also examines barriers to securing affordable coverage in…

  • Getting Connected: Can the ACA Improve Access to Health Care in Rural Communities?

    Event Date:
    Event

    Residents of rural communities face unique health care challenges, including fewer health care providers, higher rates of chronic disease, and lower adoption rates of health information technology. This October 13 briefing, cosponsored by the Alliance for Health Reform and the United Health Foundation, looked at the many provisions in the Patient Protection and Affordable Care Act (ACA) that speak to the needs of rural communities, with a focus on boosting the health care workforce and…

  • Accountable Care Organizations: A New Paradigm for Health Care Delivery?

    Event Date:
    Event

    The health reform law of 2010 authorizes Medicare, beginning next year, to contract with accountable care organizations (ACOs) in a Medicare Shared Savings Program. ACOs provide financial incentives to improve the coordination and quality of care for Medicare beneficiaries, while reducing costs. But providers have raised red flags, saying the arrangements are burdensome and too hard to achieve. This briefing addresses questions raised by the law and the subsequent regulation implementing ACOs, including: How will…

  • 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 of Care

    Report

    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 of Care This report documents the relatively high rates of hospital stays, emergency room visits and skilled nursing facility admissions among long-term care facility residents. It finds that Medicare per capita spending for Medicare beneficiaries living in nursing homes, assisted-living centers and other long-term care facilities, $14,538 in…

  • Statement of Gary Claxton to NAIC Exchanges (B) Subgroup

    Event Date:
    Event

    Kaiser Family Foundation Vice President Gary Claxton, who directs the Foundation's Marketplace Policy Project, testified July 22, 2010, at a public hearing before the National Association of Insurance Commissioners' Exchanges (B) Subgroup established by the health reform law.  Testimony (.pdf)

  • Immigration Reform and Access to Health Coverage: Key Issues to Consider

    Issue Brief

    The Obama administration and a bipartisan group of U.S. senators recently released blueprints for immigration reform proposals that include a roadmap to citizenship for the 11 million undocumented immigrants currently residing in the United States. Subject to meeting specified requirements, these individuals would be able to apply for a provisional lawful status. After completing an undefined number of years in this status, an individual would then be allowed to apply for lawful permanent residency and,…