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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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  • Implications of “Medicare for All” and “Public Plan” Strategies: New Brief and Interactive Tool Summarize Legislative Proposals and Key Issues

    News Release

    The idea of expanding the role of government programs such as Medicare and Medicaid has received renewed attention on Capitol Hill and on the campaign trail this year as policymakers consider ways to expand health insurance coverage and moderate health care costs. Lawmakers have introduced eight such proposals in the current Congress. They range from bills that would create a new, all-encompassing national health insurance program (sometimes called “Medicare-for-All”) to less sweeping measures that would…

  • Web Briefing for Journalists: Key Issues Ahead of Marketplace Open Enrollment

    Event Date:
    Event

    Marketplace open enrollment, the period during which consumers can shop for health plans or renew existing coverage through the Affordable Care Act’s health insurance marketplaces, begins on Nov. 1. Recent policy changes at the state and federal levels have the potential to impact individuals and families purchasing health insurance for 2019. It’s the first open enrollment period following Congress’ repeal of the ACA’s individual mandate penalty, the requirement that individuals have minimum essential health coverage…

  • Enrollment in the Individual Insurance Market Continued to Fall in the First Quarter of 2018, With the 12 Percent Overall Decline Concentrated in Off-Exchange Plans

    News Release

    Enrollment in the individual insurance market continued to shrink in the first quarter of 2018, declining by 12 percent compared to the first quarter of 2017, according to a new analysis from the Kaiser Family Foundation. The decline was concentrated in off-exchange plans where enrollees are not eligible for Affordable Care Act subsidies and have had to pay the full cost of recent premium increases. At the same time, enrollment in plans sold through the…

  • Short-Term Health Insurance Plans Charge Less than Half as Much in Premiums as ACA Plans By Excluding Pre-Existing Conditions and Severely Limiting Benefits

    News Release

    Short-term health insurance plans offer a trade-off for consumers: substantially lower premiums than plans that comply with the Affordable Care Act, but much less protection if they get sick and need care. Just how much cheaper are the premiums and what are consumers giving up to get them? A new KFF (Kaiser Family Foundation) analysis finds short-term plans are able to charge premiums 54 percent lower than ACA-compliant plans, by excluding pre-existing conditions and severely…

  • What Does the Outcome of the Midterm Elections Mean for Medicaid Expansion?

    Fact Sheet

    While not typically an election issue, Medicaid — particularly the Medicaid expansion created under the Affordable Care Act (ACA) — was an important issue in the 2018 midterm elections in a number of campaigns throughout the country. This fact sheet highlights key states in which the results of the 2018 midterm elections have implications for Medicaid adoption or implementation. States examined include those that had Medicaid expansion ballot initiatives as well as states that have…

  • The New Health Care Agenda: Gridlock, Lots of Hearings

    From Drew Altman

    In an Axios column, Drew Altman analyzes what the midterm election means for the health policy agenda between now and 2020--mostly political positioning and gridlock in Congress, with most of the action affecting people in the states. 

  • More Insurers Are Participating in the ACA Marketplaces in 2019

    News Release

    Insurer participation in the Affordable Care Act’s health insurance marketplaces is rising in 2019, finds a new analysis from KFF (the Kaiser Family Foundation).The increase follows consecutive years of improving insurance company profits and shows up in several different ways: Going into 2019, 608 counties nationwide are gaining at least one insurer in the marketplace, while only five counties will lose an insurer. In 2019, roughly 17 percent of enrollees (living in 37 percent of…