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Affordable Care Act

The ACA MarketplaceS

How Has Marketplace Enrollment Changed Across States in 2026?

Following several years of rapid enrollment growth in the ACA Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the enhanced tax credits, generally saw lower drops in enrollment.

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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  • 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…

  • 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)

  • 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…

  • 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,…

  • Pulling it Together: Health Reform’s Six-Month Checkup

    Perspective

    Six months after its enactment, there are two totally different stories to tell about the health-reform law. The public remains split on the law largely along traditional partisan lines. Confusion and misperception are rampant, with more than a third of seniors still thinking the law contains "death panels" (it does not). Yet beneath the political battle lies a success story of early implementation: The federal government that many regard as sluggish and ineffective has turned…

  • Health Reform Hits Main Street

    Video

    This short cartoon explains the problems with the current health care system, the health reform changes that are happening now, and the big changes coming in 2014 as part of the Affordable Care Act (ACA). You can view the video on our site and it is also available on YouTube.