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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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  • Round 3: Legal Challenges to Contraceptive Coverage at SCOTUS

    Issue Brief

    This brief explains how the new regulations issued by the Trump Administration would change the contraceptive coverage requirement for employers and affect women’s coverage, the legal positions for challenging and defending these regulations, the potential rulings, and the broader ramifications.

  • Poll: As States Start to Ease Coronavirus Restrictions, Few Americans Expect to Stay in Hotels or Fly This Summer, Though Most Plan to Visit a Doctor, Get a Hair Cut and Dine Out

    News Release

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  • Democrats Like Medicare-for-All, but Swing Voters Don’t

    From Drew Altman

    Medicare-for-all is popular with Democrats in battleground states, but not with swing voters. In this Axios column, Drew Altman discusses the implications of the KFF-Cook Political Report poll findings. 

  • Poll: On Health Care, Democrats and Democratic-Leaning Independents Trust Sen. Sanders the Most, but Significantly More People Support a Public Option than Medicare-for-All

    News Release

    3 in 4 Americans Do Not Expect Congress to Take Action to Lower Drug Costs Before the 2020 Election Ahead of tonight’s Democratic presidential debate, Sen. Bernie Sanders is the candidate most trusted on health care by Democrats and Democratic-leaning independents, though the Medicare-for-all plan he has championed is significantly less popular than the “public option” approach put forward by some other candidates, the latest KFF Health Tracking Poll finds. Among the overall public, a…

  • How Many of the Uninsured Can Purchase a Marketplace Plan for Free in 2020?

    Issue Brief

    This analysis looks at how many of the remaining uninsured are eligible for premium subsidies that are large enough to cover the entire cost of a bronze plan, which is the minimum level of coverage available on the Marketplaces. It estimates 28% of uninsured individuals who could shop on the ACA Marketplace, or 4.7 million people nationwide, are eligible to purchase a bronze plan with $0 premiums after subsidies in 2020.

  • 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…

  • 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…

  • 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.

  • Health Policy in 2020 Will Be Made in the States

    From Drew Altman

    With a questionable outlook for 2020 passage of legislation on prescription drug pricing and surprise medical bills, Drew Altman says the real action to watch in health policy is likely to be in the states.