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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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  • A Profile of Health Insurance Exchange Enrollees

    Report

    The Patient Protection and Affordable Care Act calls for the creation of Health Insurance Exchanges in all states by January 1, 2014. The exchanges are a critical element of the health reform law, aimed at helping individuals and families shop for and purchase health insurance on their own with additional assistance for lower-income individuals and families. The Congressional Budget Office has estimated that approximately 24 million people will purchase coverage through the state health exchanges…

  • Mobile Technology: Smart Tools to Increase Participation in Health Coverage

    Issue Brief

    As mobile technology advances and cell phone use continues to increase across demographic groups, there is significant potential to tap these technologies to facilitate enrollment in and retention of health coverage, in both the immediate term and as health reform is implemented. A brief produced in conjunction with The Children's Partnership examines how various tools and strategies, including text messages and smart phone apps, can be used to advance coverage goals. The report focuses especially…

  • Medicaid Matters: Understanding Medicaid’s Role in Our Health Care System

    Fact Sheet

    This fact sheet provides key information about the Medicaid program and its role in our health care system and state economies. The nation’s public health insurance program for low-income people is counter-cyclical, expanding during the recent recession to assist millions of individuals and families affected by the loss of jobs and job-based health insurance. While the program has worked as intended, economic conditions have contributed to growing pressure on state budgets and Medicaid funding. This…

  • Determining Income for Adults Applying for Medicaid and Exchange Coverage Subsidies: How Income Measured With a Prior Tax Return Compares to Current Income at Enrollment

    Issue Brief

    A major goal of the Patient Protection and Affordable Care Act (ACA) is to significantly expand coverage and reduce the number of uninsured. Beginning in 2014, the ACA will establish a new continuum of coverage that will provide assistance to individuals with incomes up to 400% of poverty through a broad expansion in Medicaid and by making premium tax credits available to eligible individuals to purchase coverage through new Health Insurance Exchanges. The law standardizes…

  • KFF February Health Tracking Poll: Nearly Half Confused About Status of the Health Reform Law

    Perspective

    In the latest Kaiser Health Tracking Poll, nearly half of Americans say they are confused about the status of the health reform law. While 52 percent of the public is aware that health reform is still law, 22 percent think the law has been repealed and is no longer law and another 26 percent are not sure. Americans are still divided about what they want lawmakers to do on health reform. Three in ten say…

  • The Budget: What Would You Cut?

    Perspective

    As President Obama and Congress begin to hash out the 2012 budget, it is a good time to revisit results from our January 2011 survey showing that in spite of the fact that most Americans report being very concerned about the budget deficit, there is little public support for major reductions across a number of program areas. Majorities said they would not support any reductions in Social Security (64 percent), public education (63 percent), or…

  • Shared Medical Decision Making: We’re in This Together

    Event Date:
    Event

    In recent years, awareness of the patient’s important role in managing his or her own care has been steadily growing—fed not only by such trends as the proliferation of health information on the internet and direct-to-consumer advertising, but also by the emerging science of patient-centered decision making. One way to facilitate shared decision making is through the use of decision support tools, which offer the patient high quality medical information in an easily understandable format.…

  • Pulling it Together: Forget Math and Science, Teach Civics (Or Why We Need to Bring Back Schoolhouse Rock)

    Perspective

    I am seldom surprised by our poll findings, but this month’s tracking poll produced a doozy.  Twenty-two percent of the American people think the Affordable Care Act has been repealed, and another 26 percent aren't sure.  Those are surprisingly large numbers even with the 52 percent who still know it is the law of the land. How could a repeal "vote" in the House -- however dramatic but still, only symbolic -- be misunderstood as…

  • Pop Quiz: Assessing Americans’ Familiarity with the Health Care Law

    Perspective

    Based on the December Kaiser Health Tracking Poll, the latest KFF data note explores Americans’ awareness of what the Affordable Care Act (ACA) will do. As the 112th Congress prepared to take office and the discussion of repeal was on the rise, we 'quizzed' Americans on whether they thought a series of ten provisions were included in the new law, ranging from five items that are part of the law (i.e., Medicaid expansion, changes in…

  • Kaiser Health Tracking Poll — February 2011

    Feature

    In the wake of the health reform repeal vote in the U.S. House and the ongoing legal challenges over the individual mandate, nearly half the country either believes that the Patient Protection and Affordable Care Act (ACA) has been repealed and is no longer law (22 percent) or doesn’t know enough to say whether it is still law (26 percent). Roughly half of Americans (52 percent) accurately report that the ACA is still the law…