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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  • Survey: Adjusting to Sudden Reduction in Federal Funds, ACA Navigators Expect to Decrease Services

    News Release

    Many navigator organizations responsible for helping consumers understand and sign up for health coverage in 2018 Affordable Care Act (ACA) marketplaces say steep federal funding reductions that recently took effect will likely force them to limit their geographic service area, cut back outreach and public education, lay off staff members, and curtail other assistance, according to a new Kaiser Family Foundation survey of such programs. The navigators’ planned adjustments are in response to the government’s…

  • Poll: 7 in 10 Want the Trump Administration to Make the Affordable Care Act Work Rather Than Make it Fail

    News Release

    As the Trump administration begins implementing Thursday’s executive order aimed at providing alternatives to the Affordable Care Act’s marketplace plans, a new Kaiser Health Tracking Poll finds a large majority of the public (71%) want President Trump and his administration to do what they can to make the current law work. Fielded just prior to Thursday’s executive order, the poll finds fewer Americans (21%) say that the president and his administration should do what they…

  • As Senate Weighs Bipartisan Stabilization Bill with Cost-Sharing Reduction Funding, Current Marketplace Enrollees Face Challenges with Affordability 

    News Release

    Knowledge and Awareness of Key Facts Regarding Enrollment Is Low As the Nov. 1 start of the Affordable Care Act’s open enrollment period nears, new polling data from the Kaiser Family Foundation finds that most potential enrollees are unaware of when they can enroll and have not seen any related advertisements. Fielded prior to yesterday’s announcement of a bipartisan marketplace stabilization deal in the Senate that among other things would increase outreach funding, the survey…

  • Keeping the Alexander-Murray Health Care Bill in Context

    From Drew Altman

    This Drew Altman Axios column describes the scale of the problems in the ACA marketplaces and the public’s confusion about whether they are impacted. He says that the news media, experts and policy makers can do more to put the marketplace problems and fixes in context as debate evolves.

  • How Premiums Are Changing In 2018

    Issue Brief

    Maps illustrate how premiums in Affordable Care Act (ACA) marketplaces changed for 2018 by looking at the change in the lowest-cost bronze, silver and gold plans by county; counties where an individual’s tax credit covers the full premium of the lowest-cost bronze plan; and counties where the unsubsidized premium for the lowest-cost gold plan has a lower or comparable premium to the lowest-cost silver plan in 2018.

  • One Big Thing People Don’t Know About Single Payer

    From Drew Altman

    In this Axios column, Drew Altman discusses a challenge for single payer which has not received much attention – a large share of the American people do not think they would have to change their current health insurance arrangements if there were a Medicare-for-all style single payer plan.

  • FAQs: What’s the Latest on IPAB?

    Issue Brief

    The Independent Payment Advisory Board was authorized by the Affordable Care Act to help slow the growth in Medicare spending. These FAQs address common questions about IPAB, including how it was designed to operate and the implications of eliminating it.

  • How Many of the Uninsured Can Purchase a Marketplace Plan for Less Than Their Shared Responsibility Penalty?

    Issue Brief

    For people who are uninsured and eligible for Affordable Care Act (ACA) marketplace plans, the analysis compares the cost of a premium for the lowest-cost bronze plan with the estimated individual mandate tax penalty for 2018. It finds that more than half (54% or 5.9 million) of the 10.7 million people could pay less in premiums for health insurance than they would owe as an individual mandate tax penalty for lacking coverage.

  • Individual Mandate Penalty Calculator

    Interactive

    The Individual Mandate Penalty Calculator estimates your penalty for going uninsured vs. how much you would pay for health insurance coverage on the Affordable Care Act (ACA) marketplaces.