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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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  • August Kaiser Health Tracking Poll: A Look At The GOP As The Republican Convention Draws Near

    Perspective

    Despite the ongoing focus on Republican opposition to the Affordable Care Act (ACA), the latest Kaiser Health Tracking Poll finds that the ACA is not the top health care priority among Republicans. While jobs are still the number one issue, when asked about the health care issues that will impact their vote this fall, Republicans’ top concern was the cost of health care and insurance, named by two-thirds as either “extremely” or “very important” to…

  • Transparency and Complexity

    Perspective

    This fall a new rule takes effect requiring all private health plans to offer a uniform, simple to read, summary of benefits and coverage (SBC).  The SBC will provide consumers with standardized information about how plans cover essential health benefits and what coverage limits and cost sharing applies. The SBC is one of the most popular provisions of the ACA.  Consumers often find health insurance difficult to understand and would no doubt welcome a plainly written…

  • Medicaid Managed Long-Term Services and Supports: Are More Caution and Oversight Needed?

    Event Date:
    Event

    The Alliance for Health Reform and AARP sponsor an August 3rd briefing to discuss who is being served by Medicaid managed care, how enrollment is determined, and whether sufficient oversight of the programs exist. Speakers will explore such questions as: Does Medicaid managed care cover a full range of long-term services and supports, including home- and community-based services? Is Medicaid managed care as a strategy part of state plans for 2014, and the challenges and…

  • Health Homes for Medicaid Beneficiaries with Chronic Conditions

    Issue Brief

    This brief profiles four states that were the first to receive federal approval to take up a state option under the Affordable Care Act to implement health homes for Medicaid beneficiaries with chronic conditions. Almost half of the 9 million people who qualify for Medicaid on the basis of disability suffer from mental illness and 45 percent have three or more diagnosed chronic conditions. Health homes provide an important tool for states trying to manage…

  • A Historical Review of How States Have Responded to the Availability of Federal Funds for Health Coverage

    Issue Brief

    This historical review finds that the availability of federal funds has served as an effective incentive for states to provide health coverage to meet the health and long-term care needs of their low-income residents despite state budget pressures. The brief examines the history of earlier experiences and provides important context for how states may respond as they weigh the costs and benefits of expanding their Medicaid programs in 2014 as called for under the Affordable…

  • Implementing the ACA’s Medicaid-Related Health Reform Provisions After the Supreme Court’s Decision

    Issue Brief

    On June 28, 2012, the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act (ACA). A majority of the Court also found the ACA’s Medicaid expansion unconstitutionally coercive of states, while a different majority of the Court held that this issue was fully remedied by limiting the Health and Human Services (HHS) Secretary’s enforcement authority. The practical effect of the Court's decision makes the Medicaid expansion optional for states. This brief addresses questions…

  • A Guide to the Supreme Court’s Decision on the ACA’s Medicaid Expansion

    Issue Brief

    On June 28, 2012, the U.S. Supreme Court issued its decision in the case challenging the Affordable Care Act (ACA). The Court upheld the constitutionality of the ACA's individual mandate, which requires most people to maintain a minimum level of health insurance coverage beginning in 2014. A majority of the Court also found the ACA's Medicaid expansion unconstitutionally coercive of states, while a different majority of the Court held that this issue was fully remedied…

  • How Five Leading Safety-Net Hospitals Are Preparing For The Challenges and Opportunities of Health Care Reform

    Report

    This study, published in the journal Health Affairs, examines how five leading safety-net hospitals are preparing for major changes expected to result from the Affordable Care Act (ACA), including less government support for uncompensated care and the need to compete for newly insured people. The hospitals studied are Bellevue Hospital Center in New York City; Denver Health Medical Center in Colorado; Parkland Health and Hospital System in Dallas; San Francisco General Hospital in California; and…

  • July Kaiser Health Tracking Poll: A Focus On The Mandate and the Medicaid Expansion in the Aftermath of the Supreme Court Decision

    Perspective

    This second July poll reports in further depth on public opinion about the Affordable Care Act (ACA) in the wake of the Supreme Court decision. The Supreme Court’s decision that the individual mandate was constitutional as a tax appears to have had little impact on opinion about the already largely unpopular requirement that most people have health coverage or potentially face a penalty. Sixty-six percent of the public view the mandate negatively when it is…