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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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  • Explaining Health Reform: Questions About the Temporary High-Risk Pool

    Issue Brief

    The health reform law creates a temporary national high-risk pool to provide health coverage to people with pre-existing medical conditions who have been uninsured for six months. It is a temporary measure designed to bridge the gap until the implementation of other coverage provisions in the law that will take effect in January 2014. This summary provides answers to basic questions about the high-risk pool program. Brief (.pdf)

  • Coverage of Low-Income Children: Key Issues to Consider in Health Reform

    Issue Brief

    A key element of health reform will be meeting the needs of low-income children. Overall, a major goal of proposals is to expand coverage by building on Medicaid, providing subsidies to low- and moderate-income individuals to buy coverage through new health insurance exchanges, and requiring individuals to obtain coverage. Current proposals also could significantly change coverage for some children already eligible for Medicaid and CHIP. This issue brief examines several key issues to consider about…

  • Survey on the Role of Health Care Interest Groups–Summary and Charts

    Poll Finding

    This summary and chartpack are from a survey conducted jointly by NPR, the Kaiser Family Foundation, and the Harvard School of Public Health examines the public’s views and opinions of the role of health care interest groups in the ongoing federal health care debate. The survey examines whether people feel their views are represented in the ongoing legislative process and their level of trust in different groups. The survey is part of a series of…

  • The COBRA Subsidy and Health Insurance for the Unemployed

    Issue Brief

    With the nation's unemployment rate rising to its highest levels in decades as a result of the recession, many families have lost their employer-sponsored health coverage or are at risk of doing so. In an effort to help people maintain coverage after a layoff, the stimulus legislation known as the American Recovery and Reinvestment Act of 2009 provides temporary subsidies to some workers so that they can maintain their previous employer-sponsored coverage through COBRA after…

  • The Public’s Health Care Agenda for the New President and Congress

    Poll Finding

      The Public's Health Care Agenda for the New President and Congress This survey captures the public's attitudes regarding the health care agenda for President Obama and the new Congress in 2009. It assesses the relative priority placed on health care by the American public as part of addressing the economic recession and as a large scale reform issue. The public's priorities for health care reform and their views on a range of other health…

  • Health Coverage in an Economic Downturn: Impact of Tight Budgets on Families and States

    Fact Sheet

    The economic downturn has strained family finances and prompted some Americans to cut back on medications and forgo preventive care and visits to the doctor. At the same time, the downturn has triggered declines in tax revenue that inhibit states’ ability to meet rising Medicaid program costs as enrollment spikes during economic hard times. Many states are expected to struggle to close budget gaps despite moves by Congress and the Obama Administration to temporarily boost…

  • Trends in Access to Care Among Working-Age Adults, 1997-2006

    Issue Brief

    Trends in Access to Care Among Working-Age Adults, 1997-2006 This policy brief finds about 39 million working-age adults nationally reported cost as a barrier to receiving needed health care in 2006, a number that grew by an average of 1 million people annually over the decade studied. Uninsured working-aged adults experienced the most consistent erosion over the 10 years, resulting in a widening gap in access to care between insured and uninsured adults. Policy Brief…

  • Kaiser Health Tracking Poll: October 2012

    Feature

    The October Health Tracking Poll finds, one week before the presidential election, the economy remains the primary concern on voters' minds, but health policy issues remain in the mix. The new survey finds that roughly a third of likely voters name the Affordable Care Act (37%), Medicare (36%), and Medicaid (30%) as "extremely important" to their vote, compared to half (52%) who say the same about the economy and jobs. But separate health care issues…

  • Current and Emerging Issues in Medicaid Risk-Based Managed Care: Insights from an Expert Roundtable

    Issue Brief

    Half of all Medicaid enrollees receive care through comprehensive risk-based managed care organizations (MCOs). Most Medicaid MCO enrollees today are low-income children and parents, but states are increasingly moving beneficiaries with more complex needs into MCOs. Managed care enrollment may grow more rapidly as states work with the Centers for Medicare & Medicare Services (CMS) to implement initiatives to better integrate Medicare and Medicaid benefits and care for dual eligibles. The Foundation’s Kaiser Commission on…