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Affordable Care Act

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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  • Americans’ Views on the Affordable Care Act Hold Steady, with 43% Now Viewing It Favorably and 42% Unfavorably

    News Release

    Few Report Seeing Comparative Information about Health Care Prices and Quality, and Less Than 10% Use It Pocketbook and Consumer Issues Top Public's List of Priorities for the President and Congress, Ahead of Several ACA-Related Issues This month's Kaiser Health Tracking Poll finds public opinion on the health care law holding steady and closely divided. The share expressing a favorable view (43%) exceeds the share with an unfavorable view (42%) for the first time since…

  • At Tax Time, No Public Backlash Over Obamacare’s Individual Mandate

    From Drew Altman

    This was published as a Wall Street Journal Think Tank column on April 21, 2015. Tax season has come and gone with no great outbreak of protest about the Affordable Care Act’s least popular provision: the individual mandate. This central element of the ACA was included to help ensure that the individual insurance market would have balanced pools of healthier people and sicker people to help spread insurance risk and keep premiums reasonable. While most of the…

  • At Tax Time, No Public Backlash Over Obamacare’s Individual Mandate

    News Release

    As tax season closes, Drew Altman looks at why the ACA’s individual mandate and tax credit reconciliation process “passed their first major hurdles this tax season with no significant public backlash,” in his latest column for The Wall Street Journal's Think Tank.

  • Data Note: How Has the Individual Insurance Market Grown Under the Affordable Care Act?

    Issue Brief

    This data note examines changes in the individual insurance market under the Affordable Care Act. Through analysis of filings by insurers to state insurance departments, the Kaiser Family Foundation estimates that the number of people enrolled in the individual insurance market grew 40 percent from the end-of-year 2013 to the end-of-year 2014 and has likely continued growing in 2015 as well.

  • How Are Hospitals Faring Under the Affordable Care Act? Early Experiences from Ascension Health

    Issue Brief

    Expanded health insurance coverage through the Affordable Care Act (ACA) is having a major impact on many of the nation’s hospitals through increases in the demand for care, increased patient revenues, and lower uncompensated care costs for the uninsured. This report examines the early experiences with the ACA by Ascension Health, the delivery subsidiary of the nation’s largest not-for-profit health system, Ascension. It finds that, overall, Ascension hospitals in Medicaid expansion states saw increased Medicaid…

  • Americans’ Health Priorities Diverge From Washington’s Focus on Obamacare

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman finds the public’s health-care priorities have more to do with drug costs and other real-world issues people deal with using the health-care system than the ongoing partisan wrangling over the Affordable Care Act. All previous columns by Drew Altman are available online.

  • 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,…

  • Access to Care for the Insured and Remaining Uninsured: A Look at California During Year One of ACA Implementation

    Issue Brief

    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,…

  • Are More Americans Benefiting From Obamacare Than Realize It?

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman discusses why many people may not know whether or not they are benefiting from the Affordable Care Act. All previous columns by Drew Altman are available online.