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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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  • Health Affairs Article: Medicaid Expansion: Chronically Homeless Adults Will Need Targeted Enrollment and Access to a Broad Range of Services

    Issue Brief

    Homeless adults may gain access to health services under the Affordable Care Act’s Medicaid expansion, which takes effect in 2014. This study, published in Health Affairs, analyzed the health coverage, health status, and health services use of 725 chronically homeless adults with disabilities in eleven cities in the United States.

  • Key Issues in State Implementation of the New and Expanded Home and Community-Based Services Options Available Under the Affordable Care Act

    Issue Brief

    This brief summarizes the key issues identified and discussed by participants in Kaiser Family Foundation’s Commission on Medicaid and the Uninsured's July 16, 2013 roundtable meeting on state adoption of the new and expanded Affordable Care Act home and community-based services (HCBS) options. While states have made overall progress in rebalancing their long-term care systems in favor of community-based care, state adoption of ACA HCBS options has been relatively slow to date, despite the growing…

  • Helping Hands: A Look at State Consumer Assistance Programs under the Affordable Care Act

    Issue Brief

    Navigator and In-Person Assister programs created by the Affordable Care Act (ACA) will provide outreach and enrollment assistance during the open enrollment period for the new health insurance Marketplaces. This brief describes these programs, highlighting differences in how they are funded and structured and discusses some of the challenges they face.

  • How Obamacare May Be Holding Down Costs

    From Drew Altman

    In his latest column published in Politico, Kaiser President and CEO Drew Altman examines the recent historic slowdown in health-care costs and discusses whether Obamacare is a contributing factor.

  • Health-Care Deductibles Climbing Out of Reach

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman explores the trend of higher deductibles in health plans and discusses a new analysis showing that many people with private insurance don’t have sufficient financial resources to pay a mid- or high-range deductible.

  • JAMA Forum: Of SCOTUS and Chicken

    Perspective

    Larry Levitt's March 2015 post explores what could happen if the U.S. Supreme Court rules for the plaintiffs in the King v. Burwell case, the lawsuit that challenges the federal government’s authority to provide financial assistance to people who buy insurance in federally-operated marketplaces created by the Affordable Care Act.