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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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  • How Many of the Uninsured Can Purchase a Marketplace Plan for Less Than Their Shared Responsibility Penalty?

    Issue Brief

    For people who are uninsured and eligible for Affordable Care Act (ACA) marketplace plans, the analysis compares the cost of a premium for the lowest-cost bronze plan with the estimated individual mandate tax penalty for 2018. It finds that more than half (54% or 5.9 million) of the 10.7 million people could pay less in premiums for health insurance than they would owe as an individual mandate tax penalty for lacking coverage.

  • New Individual Mandate Penalty Calculator Helps Consumers Estimate Their Penalty for Being Uninsured in 2018

    News Release

    A new individual mandate penalty calculator from the Kaiser Family Foundation allows consumers to estimate how much they would owe as a tax penalty for lacking health coverage in 2018, and to compare that amount to the cost of the least expensive 2018 Affordable Care Act marketplace plan in their local area. Using household income, family size, ages of family members, and zip code data, the tool provides a projection of an individual’s penalty for…

  • 2018 Renewal Notices – What Marketplace Consumers Need to Know

    Issue Brief

    As Open Enrollment for 2018 coverage gets underway, consumers who have health coverage through the Affordable Care Act (ACA) Marketplace are again receiving renewal notices from their health insurers. Though the insurer renewal notices this year are based on the same model notice required in the past, this year for many consumers, it may be causing significant – and misleading – sticker shock. That is because renewal notices sent by insurers are required to inform…

  • Kaiser Health Tracking Poll – November 2017: The Role of Health Care in the Republican Tax Plan

    Feature

    As Republicans in Congress continue efforts to pass tax reform, the November Kaiser Health Tracking Poll examines views of the plans and how they relate to health care issues. Overall, reforming the tax code is seen as a “top priority” for President Trump and Congress by about three in ten (28 percent), falling well-behind several health care issues such as reauthorizing funding for the State Children’s Health Insurance Program (CHIP) (62 percent) and stabilizing the…

  • Early 2017 Financial Data Indicate Stabilizing Individual Insurance Market

    News Release

    Insurer financial data through the first quarter of 2017 suggest the individual market has been stabilizing and insurers in this market are regaining profitability, finds a new analysis from the Kaiser Family Foundation. The analysis tracks insurer financial performance, starting before the launch of Affordable Care Act marketplaces, through two indicators: Medical loss ratios (the share of health premiums paid out as claims) and average gross margin per member per month (the average amount by which…

  • Public Wants Republicans to Work with Democrats on Health Care

    From Drew Altman

    In this column for Axios, Drew Altman discusses a new poll finding showing substantial support for Republicans to drop repeal and work with Democrats on improving the Affordable Care Act, from the general public, Trump supporters, and Republicans.

  • Growing Majority of Americans Oppose Congress’ Plan to Repeal and Replace the Affordable Care Act

    News Release

    Intensity Gap: Democrats are Twice as Enthusiastic about the ACA than Republicans are About Its Replacement Two-Thirds of Public Oppose Major Medicaid Cuts as Part of Repeal and Replace Plan As the U.S. Senate continues to debate their plan to repeal and replace the 2010 Affordable Care Act, the latest Kaiser Family Foundation tracking poll finds the public souring on the effort with a growing majority opposed to the plan. This month’s poll finds 61…

  • State-by-State Estimates of Reductions in Federal Medicaid Funding Under Repeal of the ACA Medicaid Expansion

    Issue Brief

    Congressional debate around the Affordable Care Act (ACA) has recently included a proposal to repeal the ACA, including the provision allowing states to extend Medicaid to childless adults up to 138% FPL and providing enhanced federal funds for the Medicaid expansion. This brief provides estimates of changes in federal Medicaid funds and Medicaid coverage for adults covered through the ACA expansion if the expansion is eliminated starting in 2020. A repeal of the Medicaid expansion…

  • Medicaid Changes in Better Care Reconciliation Act (BCRA) Go Beyond ACA Repeal and Replace

    Issue Brief

    Both the Senate's Better Care Reconciliation Act of 2017 (BCRA) and the House's American Health Care Act (AHCA) go beyond repeal and replacement of the Affordable Care Act (ACA) to make fundamental changes to Medicaid by setting a limit on federal funding through a per capita cap or block grant. The BCRA also includes additional changes that would further reduce federal spending for states with high per enrollee spending, limit state financing mechanisms, allow states…