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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 Exchange Profiles: Louisiana

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    Final update made on December 13, 2012 (no further updates will be made) Establishing the Exchange Governor Bobby Jindal (R) announced that Louisiana will not pursue the establishment of a state-based health insurance exchange and instead will allow the federal government to operate an exchange in the state.1 While a bill establishing an exchange was introduced in the 2012 legislative session, it was not supported by the Governor and failed when the legislative session ended (SB…

  • State Marketplace Profiles: Colorado

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    Final update made on November 8, 2013 (no further updates will be made)  Establishing the Marketplace On June 1, 2011, Governor John Hickenlooper (D) signed SB 11-200 into law, establishing the Colorado Health Benefit Exchange.1  In January 2013, the Exchange announced that the online Marketplace would be called Connect for Health Colorado (C4HCO). Structure: The legislation defines Colorado’s Marketplace as a quasi-governmental organization, specifically a "nonprofit unincorporated public entity." Governance: The Marketplace is governed by a 12-member board.…

  • 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…

  • State Exchange Profiles: Alaska

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    Final update made on December 4, 2012 (no further updates will be made)  Establishing the Exchange On July 17, 2012, Governor Sean Parnell (R) announced that Alaska will not create a state-run health insurance exchange, and instead will allow the federal government to operate an exchange in the state.1 While a bill establishing an exchange was introduced in the 2011 legislative session and reconsidered in 2012, it failed to pass. Prior to the announcement that the…

  • State Exchange Profiles: Utah

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    Final update made on May 21, 2013 (no further updates will be made)  Establishing the Exchange After making health system reform one of the state’s top policy priorities, Utah’s former Governor Jon Huntsman (R) signed legislation in 2008 (HB 133) and 2009 (HB 188) which directed the Office of Consumer Health Services to create the Utah Health Exchange.1  Current Governor Gary Herbert (R) signed into law additional legislation amending provisions related to health system reform in…

  • State Exchange Profiles: Maine

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    Final update made on April 2, 2013 (no further updates will be made)  Establishing the Exchange On November 16, 2012, Governor Paul LePage (R) wrote in a letter to federal officials that Maine would not be pursuing efforts to implement a state-based health insurance exchange.1 Legislation establishing a state-run health insurance exchange failed to pass in 2011 and 2012. Prior to ending planning efforts, the Governor created an exchange Advisory Committee in July 2011, which included…

  • State Exchange Profiles: New Jersey

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    Final update made on December 10, 2012 (no further updates will be made) Establishing the Exchange  On December 7, 2012, Governor Chris Christie (R) vetoed A 3186/S 2135, which would have established a health insurance exchange within the Department of Banking and Insurance and announced that the state would default to a federal exchange.1Governor Chris Christie (R) vetoed similar legislation earlier in 2012.2 In 2011, the New Jersey Interagency Working Group on the ACA, led…

  • State Exchange Profiles: Oklahoma

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    Final update made on December 13, 2012 (no further updates will be made) Establishing the Exchange  On November 19, 2012, Governor Mary Fallin (R) announced that Oklahoma would not pursue the creation of a state-based health insurance exchange.1 Prior to the announcement, Oklahoma had established the Joint Committee on Federal Health Care Law to explore the state’s options regarding federal health reform, including exchange implementation in the state.2 The Joint Committee convened in 2011 and released final exchange…

  • 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 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…