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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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  • Early Analysis of 21 Major Cities Tracks ACA Marketplace Premium Changes, Insurer Participation, Uncertainty

    News Release

    As insurers grapple with continuing uncertainty surrounding 2018 Affordable Care Act (ACA) marketplaces, a new Kaiser Family Foundation analysis of initial filings in 21 major cities finds that changes in 2018 benchmark silver plan premiums are likely to range widely, from a decrease of 5 percent in Providence, R.I., to an increase of 49 percent in Wilmington, Del., without factoring in tax credits. However, the analysis finds that preliminary rates will likely change, and some…

  • Medicaid: What We Learned From the Recent Debate and What to Watch for in September 2017

    Issue Brief

    The inclusion of major Medicaid changes in both the American Health Care Act (AHCA) that passed in the House and the Better Care Reconciliation Act (BCRA) considered in the Senate revealed that is hard to gain consensus on significant cuts and reforms to Medicaid. Medicaid has broad general support and intense support from special populations served by the program. In addition, proposed changes would have different implications across states due to significant program variation across…

  • How to Keep ACA Stabilization Narrow

    From Drew Altman

    In this column for Axios, Drew Altman discusses the main challenges for members and media coverage as members take up the issue of stabilization of the Affordable Care Act.

  • King v. Burwell and Media Coverage

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman lays out the news media’s challenge covering the upcoming Supreme Court King v. Burwell decision about the ACA.

  • New Analysis Details Impact on Residents in Different States If the U.S. Supreme Court Rules for Challengers in King v. Burwell

    News Release

    The U.S. Supreme Court is expected to rule this month in the King v. Burwell case that challenges whether low- and moderate-income Americans are eligible for subsidies to help pay for insurance if they live in states where the federal government, rather than the state, established its new insurance marketplace under the Affordable Care Act (ACA). Using 2015 enrollment data released today, a new Kaiser Family Foundation analysis and interactive map breaks out how residents…

  • The ACA and People with HIV: Profiles from the Field

    Issue Brief

    This brief provides profiles of twelve individuals living with HIV to offer an in-depth look at how the Affordable Care Act (ACA) has affected their healthcare and coverage. Participants live in California, Florida, Georgia, New York, and Texas and discuss their enrollment and coverage experience, including whether they got new coverage (in the Marketplace or Medicaid), how their HIV care has been affected, and the role of the Ryan White HIV/AIDS Program.

  • The ACA and People with HIV: Profiles from the Field

    News Release

    New in-depth profiles of 12 people with HIV highlight how the Affordable Care Act’s coverage expansions impacted their access to coverage and care. While some experienced serious bumps along the way, those who gained coverage through Medicaid and the Marketplaces were largely able to meet both their HIV and non-HIV care needs. At the same time, the Ryan White HIV/AIDS Program continued to play a role in HIV care and coverage, both for those who remained…

  • Data Note: Predictors Of Positive And Negative Attitudes Towards The ACA Among Non-Group Insurance Enrollees

    Poll Finding

    One of the groups perhaps most affected by changes brought about by the Affordable Care Act (ACA) are people who purchase their own health insurance in the non-group market. In this Data Note, we examine data from the Kaiser Family Foundation Wave 2 Survey of Non-Group Health Insurance Enrollees to explore the characteristics of non-group enrollees that are associated with positive and negative attitudes towards the ACA, including feeling personally benefited or negatively affected by…