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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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  • Public Strongly Favors End-of-Life Conversations Between Doctors and Patients, With About Eight in 10 Saying Medicare and Other Insurers Should Cover These Visits

    News Release

    Six in 10 Oppose 'Cadillac Plan Tax' on High-Cost Health Plans Set to Take Effect in 2018, But Cost Savings Argument Can Change Some Opinions Views on the Affordable Care Act Remain Divided: 45% Unfavorable, 41% Favorable As the Centers for Medicare & Medicaid Services prepares to finalize a plan to pay physicians for discussing end-of-life treatment options with Medicare patients, the latest Kaiser Health Tracking Poll finds an overwhelming majority supports such coverage. The…

  • Nearly Half of the Uninsured, or 15.7 Million People, Are Eligible for Medicaid or Subsidized Affordable Care Act Coverage, Analysis Finds

    News Release

    State-Level Numbers Provide Estimates of How Many Could Be Reached During Third ACA Open Enrollment Period Weeks away from the Affordable Care Act’s third open enrollment period, a new Kaiser Family Foundation analysis finds nearly half (49% or 15.7 million) of the 32.3 million nonelderly people in the United States without health insurance at the beginning of 2015 are eligible for Medicaid or subsidized coverage through an ACA marketplace. On a state level, the share…

  • JAMA Forum: Why the Ruckus Over the Cadillac Plan Tax?

    Perspective

    Larry Levitt’s October 2015 post explains the terms of the much-debated Cadillac plan tax, how it is designed to reduce health costs, and how it could end up shifting more costs to workers.

  • GOP Views of Medicaid Expansion Differ From Conventional Wisdom

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman examines Republican attitudes on Medicaid expansion in light of last night’s election of Republican Matt Bevin as Kentucky’s next governor. All previous columns by Drew Altman are available online.  

  • Understanding Health Insurance

    Video

    The YouToons help consumers understand health insurance by explaining health insurance premiums, out-of-pocket costs, and provider networks. These three videos are excerpts from the 2014 YouToons video, Health Insurance Explained – The YouToons Have It Covered.

  • 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.

  • How Have State Medicaid Expansion Decisions Affected the Experiences of Low-Income Adults? Perspectives from Ohio, Arkansas, and Missouri

    Issue Brief

    This brief examines the experiences of low-income adults in three states that have made varied Medicaid expansion decisions: Ohio, which adopted the ACA Medicaid expansion, Arkansas which implemented the Medicaid expansion through a “Private Option” waiver, and Missouri, which has not adopted the expansion. While Arkansas and Ohio implemented the expansion in different ways, participants in both states described how obtaining coverage improved their ability to access care, contributing to improvements in their ability to…

  • 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.

  • Getting into Gear for 2014: Shifting New Medicaid Eligibility and Enrollment Policies into Drive

    Report

    On January 1, 2014, many key provisions of the Affordable Care Act (ACA) will start to go into effect, including the expansion of Medicaid to low-income adults and the launch of new Medicaid eligibility and enrollment processes, which are designed to move toward a coordinated enrollment system across health coverage programs, including Medicaid, CHIP, and the new Health Insurance Marketplaces. Over the past year, states have made steady and significant progress preparing for these changes,…

  • Webinar for Journalists: How the Affordable Care Act Affects Baby Boomers and Medicare Beneficiaries

    Event Date:
    Event

    As part of the "Covering Health Reform" series, this webinar focused on the major changes facing older people. The Foundation's Associate Director of the Program on Medicare Policy, Juliette Cubanski and Senior Fellow Karen Pollitz discussed how the Affordable Care Act impacts Medicare benefits and beneficiaries, as well as the ACA's role for baby boomers who are not yet 65 and eligible for Medicare.