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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

Promotional image for KFF video How Affordable is the Affordable Care Act

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 Affordable Care Act Doesn’t Rank Highly As an Issue for Voters in the Presidential Primaries

    News Release

    Despite Anecdotal Reports about Narrow Networks, 87% of Working-Age Adults with Insurance Are Satisfied With Their Plan's Choice of Doctors; 12% Say They Had to Change Doctors in Past Year As the ACA's Open Enrollment Nears End, Most of Those Who Remain Uninsured Are Disengaged While this month Congress passed and President Obama vetoed legislation to repeal the Affordable Care Act, voters nationally aren't focused on the law in this year's presidential election, the latest…

  • Takeaways From Alaska’s Medicaid Expansion

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman discusses the implications of the governor of Alaska’s decision to move ahead unilaterally with Medicaid expansion. All previous columns by Drew Altman are available.

  • Overview of Medicaid Per Capita Cap Proposals

    Issue Brief

    The House Republican Plan (“A Better Way”) released on June 22, 2016, includes a proposal to convert federal Medicaid financing from an open-ended entitlement to a per capita allotment or a block grant (based on a state choice). This proposal is part of a larger package designed to replace the Affordable Care Act (ACA) and reduce federal spending for health care. Often tied to deficit reduction, proposals to convert Medicaid’s financing structure to a per…

  • Two Year Trends in Medicaid and CHIP Enrollment Data: Findings from the CMS Performance Indicator Project

    Issue Brief

    This brief provides an overview of recent trends in Medicaid and CHIP enrollment as of January 2016, based on data from the Centers for Medicare and Medicaid Services (CMS) produced as part of its Performance Indicator Project. The project was designed to provide timely data on Medicaid and CHIP eligibility and enrollment that are intended to help strengthen data-driven program management and oversight efforts at both the national and state level. They also provide insight…

  • JAMA Forum: The Partisan Divide on Health Care

    Perspective

    In this post for JAMA, the Kaiser Family Foundation's Larry Levitt outlines the health care platforms of the Republican and Democratic parties, noting their fundamentally different aims and differing ideas about, among other things, the Affordable Care Act (also known as Obamacare) and Medicare.