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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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  • The Politics of Obamacare: How the Affordable Care Act is Playing in the Midterm Elections

    Event Date:
    Event

    In 2010, many political analysts and journalists cited the debate over, and enactment of, the Affordable Care Act (often called "Obamacare") as one factor that helped spark the conservative Tea Party movement and the Republican takeover of the House in that year's Midterm Elections. Four years later, the law's major coverage provisions have taken effect, resulting in new health coverage for millions of Americans, but public opinion on the law remains deeply divided along partisan…

  • Sen. Mark Pryor Spotlights the Health Law’s Rx for Pre-Existing Illnesses

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman explains why Senator Mark Pryor’s new campaign ad features the Affordable Care Act’s protections for people with pre-existing medical conditions, the somewhat forgotten “mega provision” of the law. All previous columns by Drew Altman are available online.

  • Premiums Set to Decline Slightly for Benchmark ACA Marketplace Insurance Plans in 2015

    News Release

    Analysis of 15 States and D.C. Also Finds Changes Vary Across States and Insurers Results Suggest Consumers Should Shop Carefully When Open Enrollment Begins November 15 MENLO PARK, Calif. -- An early look at the cost of health insurance in 16 major cities finds that average premiums for the benchmark silver plan – the one upon which federal financial help under the Affordable Care Act to consumers is based – will decrease slightly in 2015. …

  • Republicans Have an Edge in Voter Enthusiasm Heading Into Fall, But Few Cite ACA as Motivating Factor

    News Release

    Anti-Obamacare Ads Reaching Most Voters in Competitive Senate Races Health Care Ranks Among Several Second-Tier Issues for Voters in Midterm Elections Behind the Economy The latest Kaiser Family Foundation Health Tracking Poll finds Republicans with a modest edge in terms of voter enthusiasm, but the Affordable Care Act, also called Obamacare, is not the main motivator. The poll finds that 27 percent of Republicans say they are “more enthusiastic” about voting this year than in…

  • An Overview of Medicaid Incentives for the Prevention of Chronic Diseases (MIPCD) Grants

    Issue Brief

    This brief provides an overview of the Medicaid Incentives for the Prevention of Chronic Diseases (MIPCD) grants and highlights key findings from the interim evaluation of the program. The brief also places these grants in context of pre-Affordable Care Act (ACA) Medicaid beneficiary incentive programs and proposed programs of states that are incorporating healthy behavior incentives into Medicaid expansion waivers.

  • Connecting Consumers to Coverage: Lessons Learned from Assisters for Successful Outreach and Enrollment

    Issue Brief

    This brief highlights the experiences of Navigators and other Marketplace consumer assistance programs under the Affordable Care Act (Obamacare) in conducting outreach and providing enrollment assistance during the ACA's first open enrollment period. It provides insight into the outreach and enrollment strategies the assisters developed and identifies the keys to successfully overcoming the challenges of the first year. These insights are based on findings from focus groups with assisters in four cities: Miami, Florida; Houston,…

  • Trends in Medicaid Spending Leading up to ACA Implementation

    Issue Brief

    This paper presents data on Medicaid spending during the years leading up to the implementation of the Affordable Care Act (ACA). It uses administrative data to first examine overall spending trends and trends by service type. We then draw on additional data to analyze per enrollee spending growth during this period, both by service type and by eligibility group, to understand what drove Medicaid spending.

  • An Overview of Actions Taken by State Lawmakers Regarding the Medicaid Expansion

    Fact Sheet

    The ACA Medicaid expansion has garnered different responses from statelawmakers - Democratics and Republicans as well as governors and legislatures. While it does not cover how every state has enacted the ACA Medicaid expansion, this fact sheet highlights some of the different actions state lawmakers have taken in response to the ACA Medicaid expansion.