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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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  • Increasing Medicaid Payments for Certain Primary Care Physicians in 2013 and 2014: A Primer on the Health Reform Provision and Final Rule

    Issue Brief

    To help ensure that access in Medicaid expands to meet anticipated higher demand for care, the health reform law requires states to pay certain physicians Medicaid fees that are at least equal to Medicare’s for a list of 146 primary care services in 2013 and 2014. The idea is to attract new physicians to Medicaid and provide greater support for physicians who already participate. As a result, Medicaid fees paid to certain physicians for primary…

  • Health Insurance Market Reforms: Rate Review

    Fact Sheet

    Rate review is the process by which insurance regulators review health plans’ new or renewed rates for insurance policies in order to ensure that the rates charged are based on accurate, verifiable data and realistic projections of health costs. Historically, state insurance departments have conducted rate review, but under the Affordable Care Act (ACA), federal regulators may review rate increases in some cases. This fact sheet explains how rate review works and how the ACA…

  • Kaiser Health Tracking Poll: September 2012

    Feature

    The September poll finds with the November election fast-approaching, Medicare trails only the economy and the federal budget deficit as key priorities for voters, and interest in the federal health program is even higher among seniors. More than a third (36%) of Americans say Medicare is “extremely” important to their vote in the election, compared to 49 percent who describe the economy in such terms and 41 percent who say so about the federal budget…

  • Kaiser Health Tracking Poll: August 2012

    Feature

    This poll, conducted as the GOP prepares for its national convention, finds that the Affordable Care Act is not the top health care priority among Republicans. While jobs are still the number one issue for Republicans, when asked about the health care issues that will impact their vote this fall, Republicans' top concern was the cost of health care and insurance, named by two-thirds (67%) as either "extremely" or "very important" to their vote in…

  • Health Insurance Market Reforms: Guaranteed Issue

    Fact Sheet

    Guaranteed issue laws require insurance companies to issue a health plan to any applicant - an individual or a group - regardless of the applicant's health status or other factors. Currently, in most states, insurance companies can deny nongroup coverage to people based on their health status or their medical expenses over the past year. This means that an uninsured person who develops a certain condition, such as breast cancer, might not be able to…

  • Kaiser Health Tracking Poll — April 2012

    Feature

    The April poll gauged Americans' opinions of the Affordable Care Act (ACA) in the wake of the Supreme Court oral arguments in the legal challenges to the health reform law in March. The increased public attention to the Affordable Care Act generated by the Supreme Court's consideration of the law did not meaningfully change the public's opinion of the law overall or of the specific provision at the heart of critics' legal case against it,…

  • Kaiser Health Tracking Poll — September 2010

    Feature

    Six months since the enactment of the Patient Protection and Affordable Care Act and a month and a half before the midterm congressional elections, Kaiser's September Health Tracking Poll finds the public remains divided on the new law. Public confusion over the new health law has risen to its highest point since April. The tug of war for public opinion on health reform continues this month, with approval and disapproval staying in the same relatively…

  • Kaiser Health Tracking Poll — May 2010

    Feature

    Confusion over the new health reform law declined but remains widespread, with 44 percent of the public saying they were confused in May, compared to 55 percent in April. Moreover, more than a third of Americans (35%) say they do not understand what the impact of the law will be on themselves and their families, while 61 percent report feeling they do understand what that impact will be. Americans continue to report getting information about…

  • Kaiser Health Tracking Poll — April 2010

    Feature

    The first Kaiser Health Tracking Poll fielded since the passage of health reform last month finds that 8 in 10 Americans know that President Obama signed the legislation into law. But 55 percent say they are confused about the law and more than half (56%) say they don’t yet have enough information to understand how it will affect them personally. The poll finds that the public supports many of the provisions of health reform that…

  • Kaiser Health Tracking Poll — March 2010

    Feature

    The March Kaiser Health Tracking Poll finds the public still divided on health reform legislation, with 46 percent of Americans backing the reform proposals on Capitol Hill, 42 percent opposing them and 12 percent saying they aren't sure. Six in 10 Americans say they have heard little or nothing about budget reconciliation. And many people continue to struggle with health costs, with nearly one in five saying cost increases have caused them or their employer…