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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.

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

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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  • Health Care Reform and the CLASS Act

    Issue Brief

    This issue brief examines the Community Living Assistance Services and Supports (CLASS) program, a component of the health reform law that establishes a national, voluntary insurance program for purchasing community living services and supports that is designed to expand options for people who become functionally disabled and require long-term help. This brief describes the major components of the CLASS program including its financing, eligibility criteria, benefit design and interaction with Medicaid. Issue Brief (.pdf)

  • Health Reform Implementation: When Sausage-Making Moves Downtown

    Event Date:
    Event

    Panelists at this briefing examine what's happening behind the scenes to implement the Patient Protection and Affordable Care Act. An overview of federal policymaking and the efforts by stakeholders and others to affect final policies pertaining to the health reform law is provided. The session will look into key tools and levers available to the federal government, including formal rulemaking and other policy processes, as well as efforts by stakeholders and others to affect final…

  • Health Reform Roundtables: Charting A Course Forward

    Report

    Health Reform Roundtables: Charting A Course Forward is a series of discussions among federal officials, state officials and outside experts that provides an opportunity to share insights and explore key issues related to implementing a significant expansion of the Medicaid program as part of the new health reform law that will require most U.S. citizens and legal residents to obtain health coverage. States will be largely responsible for implementing the Medicaid expansion, which will provide…

  • Financial Alignment Models for Dual Eligibles: An Update

    Issue Brief

    The nearly nine million dual eligibles who receive both Medicare and Medicaid benefits are a high cost, high need population, accounting for a disproportionate share of expenditures relative to their enrollment in both programs. In April 2011, the Centers for Medicare and Medicaid Services (CMS) announced the award of design contracts to 15 states to develop service delivery and payment models to integrate care for dual eligibles. CMS and the participating states have recognized that…

  • Pulling it Together: How the ACA Can Help The Homeless

    From Drew Altman

    Estimates are that there are approximately 630,000 people who are homeless on any given night in the U.S. -- about two-thirds in shelters and one-third on the street or without real shelter. Several million people are estimated to experience homelessness over the course of a year. About two-thirds are individuals and the balance are in families. These numbers are virtually identical to national estimates we used when I worked intensively on the issue of homelessness in the…

  • Kaiser Health Tracking Poll: Election 2008 — September 2008

    Poll Finding

    The latest Kaiser Health Tracking Poll: Election 2008 finds that health care has crept up in importance as an election issue in recent months among a key voting group: political independents, who ranked it as highly as Democrats did in this poll.  Roughly one in four (26%) independents rank health care as one of the top issues they would "most like to hear the presidential candidates talk about." Health care's importance has risen among independents by…

  • The Decline in the Uninsured in 2007: Why Did It Happen and Can It Last?

    Issue Brief

    This policy brief examines the underlying shifts in health insurance coverage in 2007, which resulted in a 1.5 million decrease in the number of uninsured people under age 65, due to increased public coverage. This includes about 300,000 in Massachusetts, which implemented its comprehensive health reform that year. The brief also projects that the current economic downturn and rising unemployment rate likely will cause the number of uninsured to grow by at least 2 million…

  • Pulling it Together from Drew Altman: Multiple Agendas for Controlling Health Care Costs

    Perspective

    In what would be a domestic policy trifecta, we may be headed for interconnected big debates about economic recovery, entitlement programs and health reform. A core issue in the entitlement and health reform debates is the problem of rising health care costs. President Obama, now apparently fully briefed on the economic, budget and health reform realities he faces, is talking conspicuously about hard choices that may lie ahead. In a short period of time the…

  • Health Affairs Article: Beyond Incrementalism? SCHIP and the Politics of Health Reform

    Report

    This article examines the political and legislative history of the Children's Health Insurance Program and analyzes the lessons for policymakers who are contemplating broader health care reform. It was published online in the journal Health Affairs and was authored by Jonathan Oberlander, an associate professor, social medicine and health policy and management, at the University of North Carolina at Chapel Hill, and Barbara Lyons, a vice president of the Kaiser Family Foundation and deputy director…

  • Pulling it Together: The Health Care Industry’s Second Voluntary Effort

    Perspective

    The announcement that health care industry groups plan to put on the table voluntarily a package of proposals to shave $2 trillion off the rate of increase in health spending over the next ten years immediately conjures up the image of the Voluntary Effort or VE launched with similar fanfare in the Carter administration.  Back then the industry used the VE to fend off Jimmy Carter's efforts to aggressively control the costs of hospital care…