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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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  • Kaiser Health Tracking Poll – March 2018: Views on Prescription Drug Pricing and Medicare-for-all Proposals

    Feature

    More than a year into President Trump’s presidency, the March Kaiser Health Tracking Poll gauges the public’s top priorities for the president and Congress to do in the coming months. This month’s poll also measures perceptions on the cost of prescription drugs, attitudes towards policymakers’ actions to address drug prices, and views of pharmaceutical companies. In addition, with the 2018 midterm elections less than 8 months away, the KFF poll asks how important a national…

  • Poll: Public Says Drug Companies Have More Influence in Washington than the NRA

    News Release

    Democrats Split on Whether to Fix the ACA or Push for a National Health Plan; Few Democratic Voters Say a National Health Plan is Their Top Issue for the Midterms As policymakers weigh strategies to address the high cost of prescription drugs, the latest Kaiser Health Tracking Poll finds that a large majority of the public (72%) view pharmaceutical companies as having too much influence in Washington – more than say the same about the…

  • State and Federal Contraceptive Coverage Requirements: Implications for Women and Employers

    Issue Brief

    Before the ACA was passed, many states had enacted contraceptive equity laws that required plans to treat contraceptives in the same way they covered other services. In addition, since the ACA was passed, a number of states have enacted laws that basically codify in state legislation the ACA benefit rules. This issue brief provides an update on the status of the continuing litigation on the federal contraceptive requirement and explains the interplay between the federal…

  • How the Loss of Cost-Sharing Subsidy Payments is Affecting 2018 Premiums

    Issue Brief

    This analysis of 32 states and Washington, D.C., tracks data on 2018 Affordable Care Act (ACA) marketplace premium increases that insurers directly attributed to the end of cost-sharing reduction payments, which reimburse insurers for providing marketplace health plans with reduced out-of-pocket costs for lower-income people. Following months of uncertainty, the Trump administration announced on Oct. 12 that the payments would be discontinued immediately, although insurers must still offer the subsidized coverage.

  • How Premiums Are Changing In 2018

    Issue Brief

    Maps illustrate how premiums in Affordable Care Act (ACA) marketplaces changed for 2018 by looking at the change in the lowest-cost bronze, silver and gold plans by county; counties where an individual’s tax credit covers the full premium of the lowest-cost bronze plan; and counties where the unsubsidized premium for the lowest-cost gold plan has a lower or comparable premium to the lowest-cost silver plan in 2018.

  • FAQs: What’s the Latest on IPAB?

    Issue Brief

    The Independent Payment Advisory Board was authorized by the Affordable Care Act to help slow the growth in Medicare spending. These FAQs address common questions about IPAB, including how it was designed to operate and the implications of eliminating it.

  • How Many of the Uninsured Can Purchase a Marketplace Plan for Less Than Their Shared Responsibility Penalty?

    Issue Brief

    For people who are uninsured and eligible for Affordable Care Act (ACA) marketplace plans, the analysis compares the cost of a premium for the lowest-cost bronze plan with the estimated individual mandate tax penalty for 2018. It finds that more than half (54% or 5.9 million) of the 10.7 million people could pay less in premiums for health insurance than they would owe as an individual mandate tax penalty for lacking coverage.

  • Individual Mandate Penalty Calculator

    Interactive

    The Individual Mandate Penalty Calculator estimates your penalty for going uninsured vs. how much you would pay for health insurance coverage on the Affordable Care Act (ACA) marketplaces.