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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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  • Key Issues in State Implementation of the New and Expanded Home and Community-Based Services Options Available Under the Affordable Care Act

    Issue Brief

    This brief summarizes the key issues identified and discussed by participants in Kaiser Family Foundation’s Commission on Medicaid and the Uninsured's July 16, 2013 roundtable meeting on state adoption of the new and expanded Affordable Care Act home and community-based services (HCBS) options. While states have made overall progress in rebalancing their long-term care systems in favor of community-based care, state adoption of ACA HCBS options has been relatively slow to date, despite the growing…

  • How Buying Insurance Will Change Under Obamacare

    Perspective

    When the Affordable Care Act’s (ACA) health insurance marketplaces (also known as “exchanges”) go online this October, millions of people are expected to apply for private insurance coverage. Nobody expects the launch will be perfect, with no hitches and problems.  The law not only replaces a fragmented and confusing assortment of plan options in today’s individual insurance market, but it also integrates tax credits to help people pay their premiums, which requires an entirely new…

  • The Connection Between Health Coverage and Income Security

    From Drew Altman

    In this column in The Wall Street Journal's Think Tank, Drew Altman shows how expanding health coverage and improving economic security for working Americans are connected even though they are often part of separate policy debates.

  • The Connection Between Health Coverage and Income Security

    News Release

    Using data from a new Kaiser Family Foundation panel survey following the uninsured in California who gained coverage since 2010, Drew Altman's latest column in The Wall Street Journal's Think Tank shows how expanding health coverage and improving economic security for working Americans are connected even though they are often part of separate policy debates. All previous columns by Drew Altman are available online.

  • New Survey Examines Assistance Provided to Consumers During Second Affordable Care Act Open Enrollment

    News Release

    A new Kaiser Family Foundation survey of insurance brokers and assistance programs examines the help they provided to consumers during the 2015 open enrollment period for Affordable Care Act coverage. The 2015 Survey of Health Insurance Marketplace Assister Programs and Brokers provides estimates of the number of people helped and the number and type of assister programs, while offering an in-depth look at assisters’ assessments of the enrollment process in the second year of the…

  • At CMS, the Mission Is Broader Than Medicare and Medicaid

    From Drew Altman

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman discusses whether the Centers for Medicare and Medicaid Services' broad new responsibilities implementing the Affordable Care Act and a more proactive approach to Medicare payment signals that it’s time for (another) name change.

  • A Look at the Private Option in Arkansas

    Issue Brief

    Based on stakeholder interviews and early data on coverage, reduced uncompensated care costs, and other topics, this issue brief provides an initial look at implementation of Arkansas' Section 1115 Medicaid expansion demonstration waiver to require most adults newly eligible for Medicaid through the Affordable Care Act's Medicaid expansion to enroll in Marketplace plans.

  • Estimates of Eligibility for ACA Coverage among the Uninsured by Race and Ethnicity

    Issue Brief

    This analysis provides national estimates of eligibility for ACA coverage options by race/ethnicity, including Whites, Blacks, and Hispanics. We estimate coverage and eligibility as of early 2015, which is prior to the end of the 2015 Marketplace open enrollment period. Overall, this analysis finds that more than half (55%) of the total 32.3 million nonelderly uninsured are people of color, including 34% who identify as Hispanic, 14% who identify as Black, and 8% who identify…

  • The Role of Language in Health Care Access and Utilization for Insured Hispanic Adults

    Issue Brief

    The ACA coverage expansions may help mitigate some barriers people with limited English proficiency (LEP) face in accessing coverage and care. However, individuals with LEP may still face increased barriers to care with coverage. This analysis examines differences in health care experiences between English- and Spanish-speaking Hispanic adults with insurance using data from the 2014 Kaiser Survey of Low-Income Americans and the ACA.