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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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  • The Politics of Obamacare: How the Affordable Care Act is Playing in the Midterm Elections

    Event Date:
    Event

    In 2010, many political analysts and journalists cited the debate over, and enactment of, the Affordable Care Act (often called "Obamacare") as one factor that helped spark the conservative Tea Party movement and the Republican takeover of the House in that year's Midterm Elections. Four years later, the law's major coverage provisions have taken effect, resulting in new health coverage for millions of Americans, but public opinion on the law remains deeply divided along partisan…

  • Sen. Mark Pryor Spotlights the Health Law’s Rx for Pre-Existing Illnesses

    From Drew Altman

    In a column for The Wall Street Journal’s Think Tank, Drew Altman explains why Senator Mark Pryor’s new campaign ad features the Affordable Care Act’s protections for people with pre-existing medical conditions, the somewhat forgotten “mega provision” of the law.

  • Covering The ACA May Be Almost As Hard As Implementing It

    From Drew Altman

    This Pulling It Together was adapted from a column I published earlier this week in Politico, with a new introduction added. You can read the original Politico column here. The implementation of the ACA is news and the public will demand information about it. Journalists and news organizations have an obligation to cover this story.  As Kaiser CEO I serve as the publisher of our non-profit news service, Kaiser Health News, and also as the head…

  • California’s Health Care Environment and Health Reform Efforts: June 2013 Update

    Issue Brief

    This brief provides and update of the health care and health policy environment in California, discussing the budgetary environment, implementation of the state's "Bridge to Reform" Medicaid waiver, and efforts to prepare for coverage expansions and new coverage options in 2014 under the Affordable Care Act.

  • A Discussion with Leading Medicaid Directors: As FY 2013 Ends, Looking toward Health Care Reform Implementation in 2014

    Issue Brief

    The Kaiser Commission on Medicaid and the Uninsured convened a focus group discussion with Medicaid directors who serve on the Board of the National Association of Medicaid Directors (NAMD). The discussion focused on state progress and concerns about implementing the ACA including eligibility system changes and state action on the Medicaid expansion decision as well as activity around payment and delivery system reform, and other budget and enrollment trends. The discussion took place in May…

  • Health Coverage for the Black Population Today and Under the Affordable Care Act

    Fact Sheet

    The Affordable Care Act (ACA) could help many uninsured Blacks through the law’s expansion of Medicaid and the creation of new health insurance exchange marketplaces with tax credits to help moderate-income people purchase coverage. This brief provides an overview of the Black population in the U.S., their health coverage today and the potential impact of the ACA coverage expansions.

  • Helping People With HIV Navigate the Transition to ACA Coverage: Summary of a Roundtable Discussion

    Issue Brief

    In March 2013, the Kaiser Family Foundation convened key HIV/AIDS stakeholders from a variety of backgrounds to explore opportunities for maximizing the beneficial impact of the Affordable Care Act (ACA) for people living with HIV and examine strategies to help them navigate the transition to new health coverage. This report summarizes the information shared and key issues discussed at the meeting.

  • How Will the Uninsured in Mississippi Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Mississippi, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Mississippi are eligible for Medicaid or financial assistance in…