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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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  • 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 Marketplace Profiles: Delaware

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    Final update made on October 10, 2013 (no further updates will be made) Establishing the Marketplace In July 2012, Governor Jack Markell (D) indicated that Delaware would begin planning for a State Partnership Marketplace.1  Delaware will retain plan management and consumer assistance functions, and defer other Marketplace management functionality to the federal government.2  In July 2013, the state announced that the Marketplace would be called Choose Health Delaware. The Delaware Health Care Commission, housed within the Department…

  • State Marketplace Profiles: Massachusetts

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    Final update made on September 29, 2013 (no further updates will be made) Establishing the Marketplace On April 12, 2006, former Governor Mitt Romney (R) signed into law comprehensive health reform legislation designed to provide near-universal health coverage for state residents.1  The Massachusetts health reform law became the model for national health reform. An important component of the law was the creation of the Massachusetts Health Connector, a health insurance marketplace that manages several coverage programs.…

  • State Exchange Profiles: Nebraska

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    Final update made on December 19, 2013 (no further updates will be made) Establishing the Exchange On November 15, 2012, Governor Dave Heineman (R) announced that Nebraska would not establish a health insurance exchange.1Earlier in 2012, the Nebraska legislature introduced two bills (LB 835 and LB 838) to establish a health insurance exchange in Nebraska, however both failed when the legislative session concluded in April.2,3 In 2011, Governor Heineman signed LB 22 into law, which…

  • State Marketplace Profiles: Michigan

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    Final update made on November 26, 2013 (no further updates will be made) Establishing the Marketplace While Governor Rick Snyder (R) supports the creation of a State-based Marketplace, he acknowledged on November 16, 2012, that without authorizing legislation, he would plan for a State-federal Partnership Marketplace.1  The state began moving in the direction of a partnership in August 2012 due to legislative opposition that left the state unable to meet the federal timetable for implementation.2  Michigan will…

  • State Exchange Profiles: Tennessee

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    Final update made on December 10, 2012 (no further updates will be made) Establishing the Exchange On December 10, 2012, Governor Bill Haslam (R) announced Tennessee would default to a federally-facilitated health insurance exchange.1 Prior to the announcement that the state would not operate its own exchange, the Tennessee Department of Finance and Administration established the Insurance Exchange Planning Initiative to advise the Governor and Legislature on exchange implementation. The Initiative worked closely with a…

  • State Marketplace Profiles: Iowa

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    Final update made on November 18, 2013 (no further updates will be made) Establishing the Marketplace On December 14, 2012, Governor Terry Branstad (R) informed federal officials that Iowa would pursue a State-federal Partnership Marketplace.1  Iowa will assume plan management functions in the Marketplace and will continue to perform Medicaid and CHIP eligibility determinations. The state intends to transition to a fully State-based Marketplace in 2016. Contracting with Plans: The Iowa Insurance Department (IID) is responsible…

  • State Exchange Profiles: Ohio

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    Final update made on March 25, 2013 (no further updates will be made) Establishing the Exchange On November 16, 2012, Governor John Kasich (R) notified federal officials that Ohio would default to a federally-facilitated exchange; however, the state would maintain regulatory control over its insurance industry.1 The Governor also indicated Ohio would maintain control over Medicaid eligibility determinations. Prior to the announcement, the Department of Insurance in collaboration with other stakeholder agencies solicited subcontractors’ assistance for…

  • State Marketplace Profiles: District of Columbia

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    Final update made on October 1, 2013 (no further updates will be made) Establishing the Marketplace On December 20, 2011 the District of Columbia City Council gave final approval to a bill establishing the District of Columbia Health Benefit Exchange Authority (HBX) and in late January 2012, Mayor Vincent Gray (D) signed the legislation into law (Act 19-269).1  The bill was also subject to a 30-day Congressional review. In June 2013, the District of Columbia announced that its new…

  • State Marketplace Profiles: Rhode Island

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    Final update made on October 8, 2013 (no further updates will be made)  Establishing the Marketplace After the legislature failed to pass Marketplace legislation during the 2011 session, Governor Lincoln Chafee (I) signed Executive Order 11-09 on September 19, 2011, to establish the Rhode Island Health Benefit Exchange.1  In July 2013, Rhode Island announced that its Marketplace would be called HealthSource RI.2  Recommendations by the Rhode Island Healthcare Reform Commission largely informed the Governor’s decision to…