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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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  • Visualizing Health Policy: Preventive Services for Women and the Affordable Care Act

    News Release

    This month’s Visualizing Health Policy infographic takes a look at preventive health services for women, including missed opportunities for preventive counseling on risk factors (such as smoking or alcohol) and sexual health issues (such as contraception, sexually transmitted infections, and domestic violence), the effects of lack of insurance on rates of mammograms and other screening tests for women, and how costs are a barrier that cause some women to postpone preventive services or skip a…

  • New Survey Documents Women’s Health Care, Coverage and Early Experiences with the Affordable Care Act

    News Release

    A comprehensive survey released today by the Kaiser Family Foundation provides a snapshot of women and their health coverage and care during a time of transition as important Affordable Care Act insurance market changes began to take root.   These include many changes that affect women including a prohibition on using gender in setting premiums, as well as broadening access to a more comprehensive range of preventive services benefits without cost sharing. The Kaiser Women’s Health…

  • Health Coverage and Care for Youth in the Juvenile Justice System: The Role of Medicaid and CHIP

    Issue Brief

    This brief provides an overview of the health and mental health needs of girls and boys in the juvenile justice system and the role of Medicaid and CHIP in addressing those needs. It focuses on the circumstances of youth who are placed in juvenile justice residential facilities, the discontinuity of Medicaid coverage for those youth, and the options for improving coverage, continuity of care and access to needed services post-discharge, including new opportunities provided by…

  • The Virginia Health Care Landscape

    Fact Sheet

    This fact sheet provides an overview of the population health, health coverage, and health care delivery system in Virginia in the era of health reform under the Affordable Care Act (ACA).

  • Avoiding the Wrong Lessons From the VA and HealthCare.gov Problems

    From Drew Altman

    This was published as a Wall Street Journal Think Tank column on May 27, 2014. Problems with the launch of HealthCare.gov and with veterans hospitals allegedly concealing long waits for care feed a narrative that government doesn’t work. But many government programs, including Medicare and Social Security, work well. And there are as many examples of corporate bungling–GM and its ignition switches, BP in the Gulf–as there are of government bungling. One impulse when government fails is to…

  • The Affordable Care Act and Insurance Coverage in Rural Areas

    Issue Brief

    Rural populations face disparities compared to metropolitan populations in health care. While rural individuals were not more likely to be uninsured than metropolitan counterparts pre-Affordable Care Act, they were poorer and less likely to have private insurance. With coverage changes in the ACA involving an expansion of Medicaid for poor and near-poor populations, decisions by states with large rural populations may cause rural residents to have disparate access to coverage, which may exacerbate cost and…

  • What’s Driving the GOP Health Plan

    From Drew Altman

    This was published as a Wall Street Journal Think Tank column on May 30, 2014. Conservative House Republicans are pushing for a vote on a GOP health-care plan, presumably to appeal to their base, to give GOP candidates health reform ideas to talk about on the campaign trail and to show that they have a policy position beyond repealing the Affordable Care Act. Polling shows they have a ways to go. The Kaiser Family Foundation’s May tracking poll…

  • The Washington State Health Care Landscape

    Fact Sheet

    This fact sheet provides an overview of population health, health coverage, and health care delivery in Washington under the Affordable Care Act (ACA).

  • Medicaid Enrollment Snapshot: December 2013

    Issue Brief

    This report focuses on changes in monthly Medicaid enrollment between December 2012 and December 2013. This is a long standing report series that collects monthly Medicaid enrollment data for December (and June, not reported here) going back to 2000. While the most recent data included in this report predate preliminary data released by CMS that show the early effects of full implementation of the ACA, this report series is an important source of historical trend…

  • New Analysis Provides Early Look At Increase in Individual Market Enrollees 

    News Release

    A new Kaiser Family Foundation analysis of health insurer reports to state regulators provides a first glimpse of enrollment in the individual, or non-group, insurance market under the Affordable Care Act.  These initial filings reflect enrollment both through the new state insurance marketplaces created under the Affordable Care Act as well as through off-exchange plans. The analysis suggests a net increase from the end of 2013 of about 3 million to 3.5 million people with…