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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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  • 10 Key Questions on Public Option Proposals

    Issue Brief

    This issue brief presents ten, high-level key questions regarding current public option proposals supported by both Democratic presidential candidates and Members of Congress.

  • Questions about Prescription Drug Importation? KFF Has Answers

    News Release

    With lowering prescription drug costs a top priority for Americans, the Trump Administration, presidential candidates, members of Congress, and several states are proposing to allow the importation of drugs from abroad, chiefly Canada. The idea of allowing drugs to be imported from Canada and other countries is popular with Americans across the political spectrum, but has yet to be implemented due to concerns about safety, and strong opposition from the drug industry. A new KFF…

  • The Role Of Health Care In The 2020 Election

    Interactive

    This interactive map highlights what voters from the 2020 general election and Democratic primary voters said about health care as they vote, based on KFF's analysis of the state-level AP VoteCast data collected in most states. The primary election data also includes state-specific charts highlighting where health care ranks as issue, views about a single-payer health plan and a public option, and other health care findings from the AP VoteCast data with key demographic breakouts.

  • POSTPONED – The ACA at 10: What We’ve Learned from the States and How the 2020 Elections Could Shape the Future

    Event Date:
    Event

    THIS EVENT HAS BEEN POSTPONED. This planned March 18 public forum organized by the Kaiser Family Foundation and the National Academy for State Health Policy public forum has been postponed. Additional information will be posted as it becomes available. The event would have featured two panel discussions examining the Affordable Care Act's impact on states and potential changes on the horizon. The first panel includes officials from five states and will explore how states approached…

  • Coronavirus Response and the Affordable Care Act

    Issue Brief

    This post examines the Affordable Care Act's impact 10 years after its enactment and how its provisions, especially those that expand coverage opportunities, could address the health threat and economic upheaval caused by the coronavirus pandemic.

  • Poll: Just Over Half of the Nation’s Workforce Have Lost a Job or Income Due to Coronavirus, though Most of Them Believe They Will Get Their Job and Income Back Within Six Months

    News Release

    With many businesses shut down and job losses mounting nationwide, just over half of the nation’s workers (55%) now say they have lost a job or had their incomes reduced as a result of the health and economic crises sparked by the novel coronavirus pandemic, the latest KFF Health Tracking poll finds. This includes a quarter (26%) of all those who were working on Feb. 1 who say they lost a job and another 7%…

  • How Many Uninsured Adults Could Be Reached If All States Expanded Medicaid?

    Issue Brief

    As more people lose their jobs and accompanying ESI, more may fall into the coverage gap, particularly starting in 2021 after unemployment benefits expire for many who have lost their jobs and incomes are likely to drop below the minimum threshold for marketplace subsidies. This analysis estimates how many uninsured adults—including those uninsured even before the pandemic and those who could become uninsured as a result of it— could become eligible for Medicaid if states…