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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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  • National ACA Marketplace Signups Dipped a Modest 3.7 Percent This Year

    News Release

    Overall ACA marketplace signups for 2018 dropped by 3.7 percent compared to last year’s enrollment period, a new analysis from the Kaiser Family Foundation finds. 11,760,533 people signed up for 2018 health insurance coverage on the ACA individual marketplaces, amid steep reductions in federal funding for outreach and navigators, an enrollment period half as long, and a climate of political uncertainty surrounding the law. The federal government also terminated cost-sharing subsidy payments to insurers in…

  • Approved Changes in Indiana’s Section 1115 Medicaid Waiver Extension

    Issue Brief

    On February 1, 2018, the Centers for Medicare and Medicaid Services (CMS) approved an amended extension of Indiana’s Healthy Indiana Program 2.0 (HIP 2.0) Section 1115 demonstration waiver. Indiana’s waiver initially implemented the ACA’s Medicaid expansion from February, 2015 through January, 2018 by modifying Indiana’s pre-ACA limited coverage expansion waiver (HIP 1.0). Unlike other states that implemented the ACA’s Medicaid expansion through a waiver, Indiana’s demonstration also changes the terms of coverage for non-expansion adults…

  • Understanding Short-Term Limited Duration Health Insurance

    Issue Brief

    In late 2017, President Trump issued an executive order directing the Secretary of Health and Human Services to take steps to expand the availability of short-term health insurance policies. This brief provides background information on short-term policies and how they differ from ACA-compliant health plans. It also analyzes the short-term plans available through two major online brokers to assess how often they include coverage for mental health, substance abuse, prescription drugs and maternity care.

  • How Single Payer Helps Republicans Change the Subject

    From Drew Altman

    In this Axios column, Drew Altman analyzes the political pros and cons of single payer for Democrats and whether it will shift the focus from the Republicans' failed effort to repeal and replace  the Affordable Care Act to the Democrats new sweeping plan.

  • 5 Ways the Graham-Cassidy Proposal Puts Medicaid Coverage At Risk

    Fact Sheet

    The Graham-Cassidy proposal to repeal and replace the Affordable Care Act (ACA) is reviving the federal health reform debate and could come up for a vote in the Senate before the budget reconciliation authority expires on September 30. This fact sheet describes five ways in which the proposal revamps and cuts Medicaid, redistributes federal funds across states and eliminates coverage for millions of poor Americans.

  • Kaiser Health Tracking Poll – June 2018: Campaigns, Pre-Existing Conditions, and Prescription Drug Ads

    Feature

    The June 2018 KFF Tracking Poll examines the top issues voters want to hear candidates talk about during their 2018 congressional campaigns, including the importance of specific health care positions such as continuing protections for people with pre-existing conditions. The Kaiser poll also examines the public’s views and experiences with prescription drug advertisements and pricing.

  • Enrollment in the Individual Insurance Market Continued to Fall in the First Quarter of 2018, With the 12 Percent Overall Decline Concentrated in Off-Exchange Plans

    News Release

    Enrollment in the individual insurance market continued to shrink in the first quarter of 2018, declining by 12 percent compared to the first quarter of 2017, according to a new analysis from the Kaiser Family Foundation. The decline was concentrated in off-exchange plans where enrollees are not eligible for Affordable Care Act subsidies and have had to pay the full cost of recent premium increases. At the same time, enrollment in plans sold through the…

  • Graham-Cassidy-Heller-Johnson Plan to Replace ACA Funding With a New Block Grant and Cap Medicaid Would Decrease Federal Funding for States by $160 Billion from 2020-2026; Then a $240 Billion Loss in 2027 if the Law is Not Reauthorized

    News Release

    The Senate is preparing to vote next week on the Graham-Cassidy proposal to repeal and replace the Affordable Care Act and to cap the Medicaid program. A new state-by-state Kaiser Family Foundation analysis finds that the major financing changes in the bill would reduce federal spending by $160 billion over the 2020-2026 period. In 2020, the new health care plan proposed by Senators Lindsay Graham and Bill Cassidy and others replaces funding for the ACA’s…

  • Data Note: Changes in 2017 Federal Navigator Funding

    Issue Brief

    This data note analyzes federal funding changes for Affordable Care Act (ACA) marketplace navigators in 2017 and discusses the implications for both the navigators and consumers. It presents results of a Kaiser Family Foundation online survey of federal marketplace (FFM) navigator programs and includes insights from a roundtable meeting of more than 40 navigators co-hosted by the Robert Wood Johnson Foundation and Kaiser Family Foundation.