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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

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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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  • Fast Track to Coverage: Facilitating Enrollment of Eligible People into the Medicaid Expansion

    Issue Brief

    To help states launch the Affordable Care Act (ACA) Medicaid expansion and efficiently enroll eligible individuals, CMS has offered states a series of facilitated enrollment options. These options include strategies, referred to as “fast track enrollment” in this issue brief, that allow states to enroll eligible individuals into coverage using data already available from their Supplemental Nutrition Assistance programs (SNAP) and/or their Medicaid or Children’s Health Insurance Program (CHIP) programs for children. This issue brief…

  • Kaiser Health Tracking Poll: November 2013

    Feature

    Amid heavy news coverage of problems with the Affordable Care Act's rollout, the November Kaiser Health Tracking Poll finds a significant negative shift in the public's views of the law, with roughly half now holding an unfavorable view and just a third holding a positive one.

  • Data Note: Attempting to Measure Early Impact of the ACA through National Public Opinion Polls- A Note of Caution and What to Watch For

    Feature

    After the October start of open enrollment, under the Affordable Care Act, many journalists, policymakers, and the public at large are eager for early data indicating how the law is working from the perspective of potential enrollees. In particular, given the problems with Healthcare.Gov and some of the state exchange websites, many people want quantitative data about people’s experiences attempting to purchase or enroll in some sort of health insurance coverage using these mechanisms. This…

  • A Profile of Community Health Center Patients: Implications for Policy

    Issue Brief

    Community health centers are a key source of primary care in underserved areas. Their role will grow as coverage expands under the ACA. To sharpen understanding of the health center patient population, this brief compares them to the low-income population overall, using the Health Center Patient Survey and National Health Interview Survey. The pre-ACA profile of health center patients that emerges sets the stage for measuring change and highlights important implications of states’ Medicaid expansion…

  • A Guide to the Supreme Court’s Review of the Contraceptive Coverage Requirement

    Issue Brief

    This issue brief dissects the issues raised by the legal challenges to the Affordable Care Act’s requirement that private insurance plans include contraception as part of their coverage of preventive services for women. Over 40 for-profit corporations and over 40 nonprofit corporations have filed lawsuits claiming that the requirement to provide their employees with contraceptives violates their religious rights. On November 26, 2013, the Supreme Court agreed to hear two cases filed by for-profit corporations,…

  • The Numbers Behind “Young Invincibles” and the Affordable Care Act

    Perspective

    As enrollment statistics in the new health insurance marketplaces start to become available, there is a growing focus on whether the enrollment of so-called “young invincibles” will be sufficient to keep insurance markets stable. Enrollment of young adults is important, but not as important as conventional wisdom suggests since premiums are still permitted to vary substantially by age. Because of this, a premium “death spiral” is highly unlikely. Why does the age distribution of enrollees…

  • How Will the Uninsured in Ohio Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Ohio, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Ohio are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Alaska Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Alaska, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Alaska are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Arkansas Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Arkansas, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Arkansas are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in California Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in California, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in California are eligible for Medicaid or financial assistance in…