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Individual Market Enrollment Declined by 18% Since June 2025

Individual Market Enrollment Fell 18%, Suggesting Continued ACA Marketplace Losses

Enrollment in the individual health insurance market fell by 18%—over 4.6 million people—from 25.2 million in June 2025 to 20.5 million in June 2026. Falling individual market enrollment suggests further decline in ACA Marketplace enrollment this year, since Marketplace enrollees represent the vast majority of individual market coverage.

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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: 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: New Hampshire

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    Final update made on November 1, 2013 (no further updates will be made) Establishing the Marketplace On June 18, 2012, Governor John Lynch (D) signed HB 1297 into law, which prohibits the state from participating in or enabling a state-based health insurance Marketplace. However, HB 1297 allows for state agencies or departments to “operate specific functions of a federally-facilitated exchange."1  Given this authority, newly-elected Governor Maggie Hassan (D) informed federal officials on February 13, 2013 that…

  • 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…