Affordable Care Act

The ACA MarketplaceS

Individual Market Enrollment Declined by 18% Since June 2025

Individual Market Enrollment Fell 18%, Suggesting Continued ACA Marketplace Losses

Enrollment in the individual health insurance market fell by 18%—over 4.6 million people—from 25.2 million in June 2025 to 20.5 million in June 2026. Falling individual market enrollment suggests further decline in ACA Marketplace enrollment this year, since Marketplace enrollees represent the vast majority of individual market coverage.

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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  • Medicaid and Its Role in State/Federal Budgets & Health Reform

    Fact Sheet

    This chartpack from the Kaiser Commission on Medicaid and the Uninsured addresses five key questions about the Medicaid program. They include: What is Medicaid and what does it do? What does Medicaid cost and why? What is Medicaid's role in state budgets? What is Medicaid's role in the federal budget? What is Medicaid's role in health reform? Chartpack (.pdf) Related fact sheet: Medicaid and Its Role In State/Federal Budgets and Health Reform

  • Why Premiums Will Change for People Who Now Have Nongroup Insurance

    Perspective

    The federal government recently released draft regulations that address the benefits, market rules, and rating practices for nongroup coverage. Before reform, the nongroup market was widely acknowledged to be broken, with restricted access, limited benefits, high administrative costs, and frequent and large premium increases subject to inadequate oversight. Recent requests for large premium hikes for nongroup coverage in some states, at a time when the group market is experiencing very low increases, have revived concerns about current pricing…

  • Explaining Health Reform: Eligibility And Enrollment Processes For Medicaid, CHIP and Subsidies in the Exchange

    Issue Brief

    The new health reform law will require most U.S. citizens and legal residents to have health coverage by 2014. It provides new options for coverage by expanding Medicaid eligibility to more low-income people and creating a state-based system of health insurance exchanges through which individuals can purchase coverage, with federal subsidies for many. This brief and accompanying explanatory chart summarize key requirements that states face under health reform to construct coordinated and consumer-friendly enrollment systems…

  • The Health-Cost Problem Is Coming Back

    From Drew Altman

    Drew Altman, in The Wall Street Journal’s Think Tank, discusses how the conversation will soon shift back to health-care costs from health coverage, because they are rising more sharply again. And as the discussion turns back, he says that because there is no national agreement on a strategy to address increasing costs, current efforts in the public and private sector, however fragmented and uncoordinated, will need to step up their game.

  • Explaining Cost-Sharing Reductions and Silver Loading in ACA Marketplaces

    Policy Watch

    The House of Representatives recently passed a budget reconciliation bill that would appropriate funding for cost-sharing reductions that insurers are required to provide to low-income enrollees in the Affordable Care Act marketplace. This policy watch explains what these cost-sharing reductions are, how they relate to federal spending, and what effect appropriating funding might have on premiums and the uninsured rate.

  • How the Trump Administration and Congress Are Reshaping the Affordable Care Act’s Marketplaces: Views from the States

    Event Date:
    Event

    Through regulations and the House budget reconciliation bill, significant changes are being considered by Congress and the Trump Administration for how the Affordable Care Act’s health insurance Marketplaces would work. To examine how these changes could reshape the ACA’s Marketplaces, KFF held a virtual briefing on June 11 featuring leaders from two state-based Marketplaces to get perspectives from the field.

  • Early Indications of the Impact of the Enhanced Premium Tax Credit Expiration on 2026 Marketplace Premiums

    Issue Brief

    Every summer, health insurers submit rate filings to state regulators detailing expectations and justifying premium rate changes for ACA-regulated health plans for the coming year. With the enhanced premium tax credits set to expire at the end of 2025, consumers can expect increases in how much they pay for coverage. KFF examines 23 early insurer premium filings from Vermont, Oregon, Washington, and Washington, DC, which include an additional 4 percent increase in premiums, on average,…

  • More Than Half of the Public Worries Federal Medicaid Budget Cuts Would Affect Their Family’s Ability to Obtain and Afford Care; More Worry It Will Increase the Uninsured 

    News Release

    As Congress weighs spending cuts and other changes to Medicaid, more than half (54%) of the public say they are worried significant reductions in federal Medicaid spending would negatively affect their family’s ability to obtain and afford health care, a new KFF Health Tracking Poll finds. This includes about three in 10 (29%) who say they are “very worried” about such an outcome.  Democrats (69%) and independents (68%) are much more likely to say they…

  • How Individual Market Enrollment Changed with the Enhanced Premium Tax Credits

    Feature

    This chart examines individual market enrollment data from 2011 through 2025, when enrollment reached a record high of 25.2 million people. Affordable Care Act (ACA) Marketplace enrollment increased following the enactment of enhanced premium tax credits in 2021, as more individuals became eligible for subsidies.

  • Poll: Most of the Public Support Extending the ACA’s Enhanced Premium Tax Credits, Including Most Republicans and MAGA Supporters

    News Release

    With the Affordable Care Act’s (ACA) enhanced premium tax credits set to expire at the end of 2025, a large majority (77%) of the public favor Congress extending the credits while about one in five (22%) say they should let them expire, the latest KFF Health Tracking Poll finds. Majorities of Democrats (91%), independents (80%), and Republicans (63%) say the enhanced tax credits should be extended by Congress, as do more than half (56%) of…