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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.

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

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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  • Quick Take: Timing Matters: States Waiting for a Supreme Court Decision to Plan an Exchange

    Fact Sheet

    State-based health insurance exchanges are an important component of the Patient Protection and Affordable Care Act (ACA) designed to extend subsidized private health insurance coverage to millions of Americans by 2014. Though projections show exchange enrollment could grow to 20 million individuals nationally, aggressive planning on the part of states will be necessary to meet implementation timelines—exchanges must be fully operational by January 1, 2014 and the Department of Health and Human Services will begin…

  • Quick Take: Geographic Variation in Dual Eligible Enrollment

    Fact Sheet

    Over 9 million elderly Americans and younger persons with disabilities are jointly enrolled in the Medicaid and Medicare programs.  These “dual eligibles” receive coverage for most medical services from Medicare, and they also receive Medicaid assistance for Medicare premiums and cost-sharing and coverage of benefits not offered under Medicare (such as long-term care).  Dual eligibles are among the sickest and poorest individuals covered by Medicare and Medicaid and, as a group, account for a disproportionate…

  • Behavioral Health: Can Primary Care Help Meet the Growing Need?

    Event Date:
    Event

    The health reform law has specific provisions covering mental health and substance use conditions, as well as general provisions to benefit those in need of behavioral health services. While addressing unmet needs, the reform law provisions raise new challenges. Given their budgetary constraints, will states be able to expand capacity to meet the demands of increased enrollment? Will sacrifices in other benefits and services be needed in order to provide mental health parity? Will the…

  • Kaiser Health Tracking Poll — May 2012

    Feature

    The May Health Tracking Poll focuses on the public's perceptions and reactions to women's reproductive health reemerging as a heated issue in policy debates and news and its potential impact on the upcoming presidential election. Three in ten women (31 percent) overall believe that there is currently a "wide-scale effort to limit women's reproductive health choices and services, such as abortion, family planning, and contraception" in the U.S. A larger share (45 percent) say there…

  • Public Opinion on Gender Rating

    Perspective

    With the Republican presidential primaries wrapping up, a barrage of new television commercials, radio ads, and fundraising emails has marked the start of the general election campaign. The Affordable Care Act (ACA) continues to be a mainstay election topic for candidates from both major parties. While Republicans focus on advocating repeal of the 2010 health care law, President Barack Obama and the Democratic Party have concentrated on the benefits of the law. And one lesser…

  • Five Key Questions About Medicaid And Its Role in State/Federal Budgets and Health Reform

    Report

    This fact sheet highlights key issues about Medicaid, including the structure, financing and purpose of the program, its role for low-income beneficiaries, its share of the federal budget and state budgets, and the significant implications of the coverage expansion under the Affordable Care Act. Fact Sheet (.pdf) Related chartpack: Five Key Questions And Answers About Medicaid

  • Emerging Medicaid Accountable Care Organizations: The Role of Managed Care

    Issue Brief

    This brief examines efforts by a number of states to set up Accountable Care Organizations (ACOs) within their Medicaid programs. An ACO is a provider-run organization in which participating providers are collectively responsible for the care of an enrolled population, and may share in any savings associated with improvements in the quality and efficiency of care. The structure of Medicaid ACO initiatives is influenced by individual states’ experience with managed care, other existing care delivery…

  • Massachusetts Health Care Reform: Six Years Later

    Issue Brief

    In 2006, then-Gov. Mitt Romney signed Massachusetts' comprehensive health reform designed to provide near-universal health insurance coverage for state residents. Building on a long history of health reform efforts, the state embarked on an ambitious plan to promote shared individual, employer, and government responsibility. This brief examines Massachusetts' experience with coverage and access to care over the last six years, as well as the state's ongoing efforts to deal with persistent high health-care costs. The…

  • The Massachusetts Health Care Landscape

    Fact Sheet

    This fact sheet summarizes the Massachusetts health care landscape, including data on demographics, population health, the uninsured and the state Medicaid program. Fact Sheet (.pdf)