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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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  • Kaiser Health Tracking Poll: Health Care Priorities for 2017

    Feature

    The most recent Kaiser Health Tracking Poll finds that health care is among the top issues, with the economy and jobs and immigration, Americans want President-elect Donald Trump and the next Congress to address in 2017. As Congressional lawmakers make plans for the future of the Affordable Care Act, the latest survey finds the public is divided on what they would like lawmakers to do when it comes to the 2010 health care law with…

  • The Health Care Plan Trump Voters Really Want

    From Drew Altman

    In a New York Times op-ed, Drew Altman draws on observations from focus groups in rust belt states of people in the Affordable Care Act (ACA) marketplaces who voted for President-elect Trump and say they may not like their coverage under the ACA but could like Republican replacement plans even less.

  • Obamacare Debate: Where GOP Governors Stand on Repeal and Replace

    From Drew Altman

    As congress prepares to vote on repeal of the Affordable Care Act, Drew Altman discusses whether Republican governors and congressional Republicans will be at odds over key issues when it comes to repealing and replacing the law in this Wall Street Journal Think Tank column.

  • Briefing on the ACA in CA: Year One & Beyond

    Event Date:
    Event

    Continuing an effort to explore Affordable Care Act (ACA) implementation in the states, the Kaiser Family Foundation and the Blue Shield of California Foundation examined ACA implementation in California (CA) at a Sacramento, Calif. briefing and panel discussion on May 28. A state official, experts and advocates discussed issues and challenges related to implementation of the law, and the practical impact of providing coverage to roughly 4.5 million Californians who have coverage via the state…

  • Coverage Expansions and the Remaining Uninsured: A Look at California During Year One of ACA Implementation

    Report

    California is a bellwether state for understanding the impact of the Affordable Care Act (ACA). Much attention has been paid to enrollment in California's new coverage options, such as the Medicaid expansion (Medi-Cal) and plans sold through ACA marketplaces (Covered California), and to changes in the uninsured from 2013 to 2014. However, less is known about how this coverage has affected people’s access to care and financial security, and why others remain uninsured. This report,…

  • Round 2 on the Legal Challenges to Contraceptive Coverage: Are Nonprofits “Substantially Burdened” by the “Accommodation”?

    Issue Brief

    The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for a broad range of preventive services including Food and Drug Administration (FDA) approved prescription contraceptives and services for women. Since the implementation of the ACA contraceptive coverage requirement in 2012, over 200 corporations have filed lawsuits claiming that including coverage for contraceptives or opting for an “accommodation” from the federal government violates their religious beliefs. This brief explains the legal…

  • Survey of Non-Group Health Insurance Enrollees, Wave 2

    Poll Finding

    The survey is the second in a series exploring the experiences and perceptions of people who purchase their own health insurance, the group perhaps most affected by the Affordable Care Act's reforms to the individual insurance market and tax subsidies to make such coverage more affordable. It includes people in ACA-compliant plans sold both inside and outside the federal and state marketplaces, as well as those still in non-compliant plans, which took effect prior to…

  • What Paul Ryan’s Stance on 2016 Means for Health Care

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman discusses the implications of Paul Ryan’s decision to rule out being drafted as a Republican presidential candidate for the 2017 health care agenda and how it could focus greater attention on proposals to change Medicare and Medicaid along with the Affordable Care Act.