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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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  • State Marketplace Profiles: Hawaii

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    Final update made on November 6, 2013 (no further updates will be made)  Establishing the Marketplace On July 11, 2011, Governor Neil Abercrombie (D) signed SB 1348 into law establishing the Hawaii Health Connector, a State-based health insurance Marketplace.1  The law builds on Hawaii’s Prepaid Health Care Act of 1975 (PHCA) which required nearly all employers to provide health insurance to employees working 20 or more hours a week for four consecutive weeks.2  Structure: The legislation established the…

  • State Exchange Profiles: Georgia

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    Final update made on December 11, 2012 (no further updates will be made) Establishing the Exchange On November 16, 2012, Governor Nathan Deal (R) announced that the Georgia had stopped planning for an exchange.1 In the previous year Governor Deal issued an Executive Order to create the Georgia Health Exchange Advisory Committee to assess whether and how Georgia should establish a health benefit exchange.2 The 25-member Committee included state officials, insurers, brokers, business representatives, consumers, and providers.3 The…

  • State Marketplace Profiles: Nevada

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    Final update made on September 26, 2013 (no further updates will be made ) Establishing the Marketplace On June 16, 2011, Nevada’s Governor Brian Sandoval (R) signed SB 440 into law establishing the Silver State Health Insurance Exchange.1  In March 2013, the state announced that the online marketplace would be called Nevada Health Link. Structure: The legislation defines Nevada’s Exchange as a quasi-governmental organization. Governance: The Marketplace is governed by a 10-member board, including three ex officio, non-voting…

  • State Marketplace Profiles: Washington

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    Final update made on November 22, 2013 (no further updates will be made) Establishing the Marketplace On May 11, 2011, Governor Christine Gregoire (D) signed SB 5445 into law establishing the Washington Health Benefit Exchange (HBE).1  Additional legislation signed by the Governor in March 2012, removed limitations on the Board’s governing authority over the Marketplace (HB 2319).2  In October 2012, the state announced that the online Marketplace would be called Washington Healthplanfinder. Structure: The legislation defines Washington’s Marketplace…

  • State Exchange Profiles: Pennsylvania

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    Final update made on December 12, 2012 (no further updates will be made) Establishing the Exchange On December 12, 2012, Governor Tom Corbett (R) notified federal officials that Pennsylvania would default to a federally-facilitated health insurance exchange.1 Prior to the announcement, the Pennsylvania Insurance Department had taken the lead with exchange planning. The Insurance Department, released an extensive report in November 2011 that suggested broad support for a state-run exchange.2 In January 2012, the Department released…

  • State Exchange Profiles: North Dakota

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    Final update made on December 11, 2012 (no further updates will be made) Establishing the Exchange In November 2012, Governor Jack Dalrymple (R) announced that North Dakota was not planning a state exchange.1 In the previous year, North Dakota had explored the possibility of a state-based exchange, spurred in part by enacted legislation stating North Dakota’s intent to create a health insurance exchange.2 The Insurance Department collected stakeholder feedback and identified a vendor to analyze the state’s…

  • State Marketplace Profiles: Idaho

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    Final update made on October 3, 2013 (no further updates will be made) Establishing the Marketplace On December 11, 2012, Governor C.L. Otter (R) announced Idaho’s commitment to the establishment of a State-based health insurance Marketplace and on March 28, 2013 signed into law legislation (HB248) creating the Idaho Health Insurance Exchange.1 2  In August 2013, the state announced that the online marketplace would be called Your Health Idaho.3  While the Governor had previously signed an Executive…

  • State Exchange Profiles: Mississippi

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    Final update made on February 11, 2013 (no further updates will be made) Establishing the Exchange In October 2011, Mississippi’s elected Commissioner of Insurance Mike Chaney (R) announced that the state would establish a Health Insurance Exchange that would be operated by the Mississippi Comprehensive Health Insurance Risk Pool Association and regulated by the Insurance Department.1 However, Governor Phil Bryant (R) has opposed the effort to establish a state-based exchange. The Comprehensive Health insurance Risk Pool…

  • State Exchange Profiles: Montana

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    Final update made on April 19, 2013 (no further updates will be made) Establishing the Exchange In December 2012, Montana’s elected State Auditor Monica Lindeen (D) confirmed that the federal government would operate a health insurance exchange in Montana.1 The previous year, two proposed bills (HB620 and HB124) to establish a health insurance exchange in Montana failed.2,3 Instead, the legislature passed SB 228, a bill that would prohibit the creation of a health insurance exchange as proscribed…

  • State Exchange Profiles: Vermont

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    Final update made on July 24, 2013 (no further updates will be made) Establishing the Exchange On May 26, 2011, Governor Peter Shumlin (D) signed into law HB 202, a far-reaching health reform law that puts the state on a path toward establishing a single-payer health care system.1  As an interim step, the law created the Vermont Health Benefit Exchange to meet the requirements of federal health reform. The state plans to put into place…