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How Has Marketplace Enrollment Changed Across States in 2026?

Following several years of rapid enrollment growth in the ACA Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the enhanced tax credits, generally saw lower drops in enrollment.

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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: 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 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: South Carolina

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    Final update made on December 10, 2012 (no further updates will be made) Establishing the Exchange On November 15, 2012, Governor Nikki Haley (R) informed federal officials South Carolina would default to a federally-operated health insurance exchange.1 This decision was largely based on findings from the South Carolina Health Planning Committee which had concluded the state cannot implement a state-based exchange as required by the Affordable Care Act (ACA) and should instead encourage the establishment of…

  • State Exchange Profiles: Wisconsin

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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 Scott Walker (R) notified federal officials that Wisconsin would default to a federally-facilitated health insurance exchange.1 After initial efforts to develop a state-based health insurance exchange, Governor Walker announced in July 2012, he would not take any action to implement federal health reform until after the November elections.2 In 2011, Walker had issued an executive order…

  • 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 Exchange Profiles: Wyoming

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    Final update made on December 11, 2012 (no further updates will be made)  Establishing the Exchange On November 14, 2012, Governor Matt Mead (R) acknowledged Wyoming would default to a federally-operated health insurance exchange for 2014, with the possibility of moving to a state-run exchange in the future.1 Governor Mead had signed HB 0050 into law in 2011 establishing the Wyoming Health Insurance Exchange Steering Committee to study the feasibility of creating a health insurance…

  • 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: 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 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: 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…