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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

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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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  • Program Integrity in Medicaid: A Primer

    Issue Brief

    Medicaid covers more than 60 million Americans and accounts for about one in six dollars spent on health care in the United States. Multiple agencies at the state and federal levels are involved in efforts to prevent waste, fraud and abuse in the program and ensure appropriate use of taxpayer dollars, and many program integrity initiatives are yielding positive results. The Affordable Care Act (ACA) builds on earlier efforts through the Deficit Reduction Act to…

  • Cost and Access Challenges: A Comparison of Experiences Between Uninsured and Privately Insured Adults Aged 55 to 64 with Seniors on Medicare

    Report

    This analysis looks at the difficulties uninsured people ages 55-64 have accessing and affording health care in 2010. Four in 10 of these near-seniors report having unmet health care needs or delaying treatment, while three in 10 uninsured near-seniors lived in families reporting problems paying their medical bills largely due to the cost. Seniors on Medicare report problems accessing care at a significantly lower rate than uninsured near-seniors and at a similar rate to near-seniors…

  • States Getting a Jump Start on Health Reform’s Medicaid Expansion

    Issue Brief

    One of the primary goals of the Affordable Care Act (ACA) is to decrease the number of uninsured through a Medicaid expansion to nearly all individuals with incomes up to 133 percent of the federal poverty level (FPL) ($14,856 for an individual or $25,390 for a family of three in 2012) and the creation of new health insurance exchanges. These coverage expansions, which will take effect in 2014, will eventually cover about 32 million uninsured…

  • Kaiser Health Tracking Poll — July 2011

    Feature

    Health care, and particularly Medicare and Medicaid, continue to play a role in the national discussion over the federal budget deficit. In the midst of this debate, the latest Kaiser Health Tracking poll finds that Americans of all political stripes see a role for both spending reductions and tax increases as part of an overall deficit reduction strategy. Still, few are willing to support major spending reductions in Medicare, and a large majority believes the…

  • Kaiser Health Tracking Poll — April 2011

    Feature

    As Congress and the president debate different approaches to reducing the deficit, the April Kaiser Health Tracking Poll indicates that initial public reaction is fairly evenly split when a premium support/voucher program like the one in House Budget Committee Chairman Paul Ryan’s "Path to Prosperity" proposal is described, but seniors prefer to keep the current Medicare system by a 2‐to‐1 margin. Meanwhile, public opinion on the health reform law remains remarkably steady. The April poll…

  • Federal Core Requirements And State Options In Medicaid: Current Policies And Key Issues

    Fact Sheet

    Medicaid is a jointly financed partnership between the federal government and states. The federal-state financing and administrative structure of Medicaid provides a framework of federal core requirements along with broad state options for program design and administration. This issue brief presents an overview of the current Medicaid program framework, with a focus on eligibility, benefits and cost sharing, care delivery and provider payment, long-term services and supports, and dual eligibles, as well as key issues…

  • Health Reform and the Tea Party Movement

    Feature

    With much media discussion of the role that the Tea Party will play in the upcoming Congressional midterm elections, this data note takes a closer look at Tea Party supporters using the most recent Health Tracking Poll data from September. While 57 percent of voters who do not support the Tea Party movement view the health reform law "very" or "somewhat" favorably, 57 percent of Tea Party supporters view the law "very" unfavorably, and another…

  • Uninsured and Untreated: A Look at Uninsured Adults Who Received No Medical Care for Two Years

    Issue Brief

    With Medicaid set to expand under health reform, the program will begin to reach individuals who have previously had little interaction with the health care system. The data in this brief profile uninsured adults with incomes at or below 133 percent of the poverty level who, because of health reform, will be eligible for Medicaid in 2014 based on income. It focuses on those who received no medical care over a two-year period to help…

  • Pulling it Together: Anticipating the Polls about Health

    Perspective

    Tuesday, February 2nd marked a milestone of sorts in the health reform debate: there was no story on health reform in the New York Times (national edition).  I haven't done a study, but as a professional New York Times (NYT) reader, I am virtually certain that this is the first day in over a year without a story in the NYT on health reform. The day of silence in the NYT is reflective of the…

  • Kaiser Health Tracking Poll — January 2010

    Feature

    The January Kaiser Health Tracking Poll finds that Americans are divided over congressional health reform proposals, but also that large shares of people, including skeptics, become more supportive after being told about many of the major provisions in the bills. The poll, conducted before the Massachusetts Senate vote, finds opinion about the legislation is split, with 42 percent supporting the proposals, 41 percent opposing them and 16 percent withholding judgment. But majorities reported feeling more…