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Affordable Care Act

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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  • Optimizing Medicaid Enrollment: Spotlight on Technology – Wisconsin’s ACCESS Internet Portal

    Issue Brief

    This brief examines how ACCESS, a web-based, self-service tool developed by the state of Wisconsin, helps Wisconsin residents find out whether they may be eligible for BadgerCare Plus and other public programs, as well as apply for benefits, check and renew benefits, and report changes to keep their eligibility current -- all online. It is the second brief in a Spotlight on Technology series profiling several states' innovative applications of technology to Medicaid enrollment efforts.…

  • More Than Meets the Eye: Long-Term Care Provisions in the New Reform Law

    Event Date:
    Event

    In the debates around the health reform law and its implementation, little attention has been given to the law's provisions supporting long-term care. This briefing offered an overview of these provisions, such as the CLASS Act, a new national, voluntary insurance program to help working adults finance services and supports that they may need in the future, and the Community First Choice Option, which helps Medicaid recipients get attendant care at home. This October 1…

  • Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long‐Term Care Facilities: A Potential for Achieving Medicare Savings and Improving the Quality of Care

    Report

    Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long‐Term Care Facilities: A Potential for Achieving Medicare Savings and Improving the Quality of Care This report documents the relatively high rates of hospital stays, emergency room visits and skilled nursing facility admissions among long-term care facility residents. It finds that Medicare per capita spending for Medicare beneficiaries living in nursing homes, assisted-living centers and other long-term care facilities, $14,538 in…

  • Medicare Advantage 2011 Data Spotlight: Plan Availability and Premiums

    Report

      This Medicare Advantage Data Spotlight provides an overview of recent changes made to the Medicare Advantage program and examines trends in plan participation, premiums and certain benefits. About 12 million people, or nearly a quarter of the Medicare population, are enrolled in Medicare Advantage, the privately administered plans that are an alternative to the traditional fee-for-service Medicare program. The analysis was conducted by a team researchers at Mathematica Policy Research, Inc. and the Kaiser…

  • To Hospitalize or Not to Hospitalize? Medical Care for Long-Term Care Facility Residents

    Report

    To Hospitalize or Not to Hospitalize? Medical Care for Long-Term Care Facility Residents This report explores factors that appear to drive relatively high rates of hospitalizations, based on interviews with doctors, nursing home staff and families in four cities. Key factors include liability concerns, limited onsite staff capabilities, difficulty reaching residents' physicians for care instructions on nights and weekends, better and more timely access to diagnostic tests in hospitals, and patient preferences. Physicians with patients…

  • Financial Incentives in the Long-Term Care Context: A First Look at Relevant Information

    Report

    Financial Incentives in the Long-Term Care Context: A First Look at Relevant Information This report reviews Medicare's payment policies as they may affect medical care for residents in long-term care environments, including a look at the financial incentives that could play a role in hospital and skilled nursing facility admissions. The report was prepared by Henry Desmarais at Health Policy Alternatives for the Foundation and released at an Oct. 12, 2010, policy briefing. Report (.pdf)

  • Briefing Examines High Medicare Spending for Beneficiaries in Long-Term Care

    Event Date:
    Event

    These three reports examine the relatively high use of hospital and other Medicare-covered services and the associated costs of medical care for Medicare beneficiaries who live in nursing homes and other long-term-care facilities. They also explore the potential for delivery system reforms to improve quality and reduce costs. Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long-Term Care Facilities: A Potential for Achieving Medicare Savings and Improving the Quality…

  • New Reports Find States Expecting 7.4 Percent Growth in Medicaid Spending In Fiscal Year 2011 As the Recession’s Lingering Effects Drive Up Enrollment

    News Release

    States Face New Budget and Workforce Challenges As Temporary Federal Aid Nears End And Health Reform Planning Heats Up WASHINGTON, D.C. – Due to the nation’s deep recession, states experienced rapid growth in their Medicaid enrollment and spending last year and expect additional growth, though at a slower pace, in fiscal year 2011, according to a survey of state Medicaid officials in all 50 states released today by the Kaiser Family Foundation’s Commission on Medicaid and…

  • Pulling it Together: A Primer on Health in the Election

    Perspective

    There is a lot of talk in polling and political circles and some speculation in the media about the role of health reform in the midterm elections. We regularly measure what the public thinks about health reform and you see reports from our monthly tracking polls about that. But whether those opinions will translate into an impact on people’s votes in the upcoming election is an entirely different question. First, to understand what might happen in…

  • KFF September Tracking Poll Looks at Health Reform and the Elections

    Perspective

    The tug of war for public opinion on health reform continues this month, with approval and disapproval remaining in the same relatively narrow band each has occupied since passage even as favorable views regain a small upper hand, 49 percent favorable vs. 40 percent unfavorable. Opinion is more closely divided among this fall’s likely voters (46 percent vs. 45 percent), and opponents of the law continue to hold their views more emphatically than supporters. Meanwhile,…