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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.

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

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: Arizona

    Other Post

    Final update made on December 4, 2012 (no further updates will be made) Establishing the Exchange  On November 28, 2012, Governor Jan Brewer (R) informed federal officials that Arizona would default to a federally-facilitated health insurance exchange.1 Prior to her decision to default, the Governor had established the Office of Health Insurance Exchange to “organize the health insurance marketplace for easier evaluation by individuals and small businesses to acquire affordable health insurance.”2 While legislation establishing a…

  • State Exchange Profiles: South Carolina

    Other Post

    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 Marketplace Profiles: Kentucky

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    Final update made on November 11, 2013 (no further updates will be made) Establishing the Marketplace On July 17, 2012, Governor Steven L. Beshear (D) issued Executive Order 587 establishing the Kentucky Health Benefit Exchange (KHBE) after the Supreme Court ruled to uphold the Affordable Care Act (ACA).1  In May 2013, the state announced that its online Marketplace would be called kynect. Prior to the Executive Order, the Kentucky Cabinet for Health and Family Services led Marketplace…

  • 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: North Carolina

    Other Post

    Final update made on February 12, 2013 (no further updates will be made)  Establishing the Exchange On November 15, 2012, Governor Beverly Perdue (D) declared the state’s intent to establish a state-federal partnership health insurance exchange.1 However, on February 12, 2013, newly-elected Governor Pat McCrory (R) issued a statement indicating that North Carolina will abandon efforts to establish a partnership exchange and will instead allow the federal government to operate the exchange.2 In 2011, Governor Perdue had…

  • 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 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: Missouri

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    Final update made on December 13, 2012 (no further updates will be made)  Establishing the Exchange On November 6, 2012, Missouri voters passed a ballot measure blocking Governor Jay Nixon (D) from establishing an exchange via Executive Order.1 Legislation establishing a state-based health insurance exchange failed in both the 2012 and 2011 legislative sessions. While the Governor initially supported running a state-based exchange, he announced the state would default to a federal exchange in 2014. Prior…

  • Pulling it Together: Business and Health Care Costs

    Perspective

    Hidden away on page 218 of our annual Employer Health Benefits Survey is a table that shows what employers think of the main strategies they have to control health care costs.  More specifically, the table shows what the person in the firm responsible for its health benefits thinks, which is whom we survey.  The short answer is, employer confidence in their own ability to control costs is not high. Not more than about a quarter…