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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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  • As the Courts Weigh the Future of the ACA’s Preventive Services Coverage, a New Analysis Shows that Most People with Private Insurance Received At Least One of Those Benefits in 2018

    News Release

    The provision of the Affordable Care Act (ACA) that requires most private health plans to cover many preventive services without any cost-sharing for their enrollees is being challenged in federal court. The U.S. District Court in the Northern District of Texas in September concluded that aspects of the requirement were unconstitutional and violated religious rights but has allowed the provision to remain in effect while it considers a remedy. As the courts consider the ACA’s…

  • Contraceptive-Only Plans: Questions and Answers

    Perspective

    In this post on The Huffington Post, Alina Salganicoff and Laurie Sobel offer a Q&A on “contraceptive-only” plans, an approach mentioned during oral arguments in the U.S. Supreme Court case Zubik v. Burwell. In the Zubik case, a group of religiously affiliated nonprofits with religious objections to providing birth control coverage seek an exemption from the Affordable Care Act's provision requiring most plans to offer such coverage without cost-sharing.

  • Visualizing Health Policy: Recent Trends in Prescription Drug Costs

    News Release

    This Visualizing Health Policy infographic spotlights national spending on prescription drugs and the public’s views on pharmaceutical prices. Prescription drug spending rose sharply in 2014, driven by growth in expenditures on specialty drugs, including medications to treat cancer and hepatitis C. Medicare’s spending on prescription pharmaceuticals also has risen, largely due to the addition of the Medicare prescription drug benefit in 2006: between 2004 and 2014, the program’s share of US drug expenditures increased from…

  • How Health Care Factors Into the Presidential Campaign

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman discusses how health care issues have cooled in the election season but matter more for certain voting groups than others, and for “health care voters” encompass more than the Affordable Care Act.

  • Florida Medicaid Reform Waiver: Early Findings and Current Status

    Issue Brief

    Florida Medicaid Reform Waiver: Early Findings and Current Status This policy brief provides an overview of the Florida Medicaid reform and a summary of available research findings to date from various evaluators of the program. It was issued at the same time as a separate Health Affairs article highlighting findings from Kaiser Family Foundation's 2006-2007 Survey of Florida Medicaid Beneficiaries. The Foundation, in collaboration with the Urban Institute and the University of Florida, is conducting…

  • Pulling It Together: Keeping the Health Reform Coalition Together

    Perspective

    We could be headed for a new schism in the debate about health reform. Not the familiar gulf between advocates of the market and government, or the predictable one between deficit hawks and spenders, but a new one that crosses traditional partisan and ideological lines between advocates of long-term reform of the health care delivery system, and immediate help for the uninsured and insured struggling with health care costs.  This new rift is most likely to develop if tight money and a crowded agenda…

  • Health Coverage in a Period of Rising Unemployment

    Issue Brief

    This policy brief reviews the public and private options available to help people maintain coverage if they become unemployed during a downturn and cannot get employer-sponsored coverage through a spouse. Specifically, it examines COBRA, non-group insurance and Medicaid. And it explains why, despite such options, more people will become uninsured as unemployment rises. Recent analysis predicts that each 1 percentage point increase in unemployment will lead to 1.1 million more uninsured adults. Issue Brief (.pdf)

  • Pulling it Together: What Will Health Reform Do For Me?

    Perspective

    There is one poll number that may be more important to watch than any other if we have a big debate about health reform: The percentage of Americans who think that they or their families would be better off if the president and the Congress enacted major health reform legislation. It's a number that signals whether people think that health reform legislation will actually help them with the problems they are having in the current…