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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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  • Poll: Most Americans Don’t Realize How Dramatically the Medicare-for-all Proposals Would Revamp the Nation’s Health Care System

    News Release

    As Congress and the Democratic presidential candidates continue to discuss Medicare-for-all and other proposals to expand public health coverage, most Americans know little about how the leading Medicare-for-all proposals would reshape the way all Americans get and pay for health care. This month’s KFF Health Tracking Poll probes the public’s awareness of key elements of proposals to create a national health plan, including the leading Medicare-for-all bills introduced by Sen. Bernie Sanders and Rep. Pramila…

  • Universal Coverage May Not Mean Everyone Has Health Insurance

    From Drew Altman

    Universal coverage is a big and important goal. But would absolutely everyone be covered under current proposals? Is it a better rallying cry for Democrats in the primaries or the general election? Drew Altman analyzes these questions in an Axios column.

  • About 1 in 6 Emergency Visits and Hospital Stays Had At Least One Out-of-Network Charge in 2017

    News Release

    In roughly 1 of every 6 emergency room visits and inpatient hospital stays in 2017, patients came home with at least one out-of-network medical bill, a new KFF analysis finds. More specifically, 18 percent of all emergency visits and 16 percent of in-network hospital stays had at least one out-of-network charge, leaving patients at risk for surprise medical bills, according to the analysis of claims data from large employer plans. The analysis also finds the…

  • Uwe Reinhardt’s New Book Priced Out: His Health Policy Ideas in Today’s Debates

    Event Date:
    Event

    Dr. Uwe Reinhardt is a giant in the health policy field who advised policymakers and influenced debates about the nation’s health system before his passing in 2017. His recently released last book, Priced Out: The Ethics and Economics of Health Care, completed by his wife and longtime collaborator Tsung-Mei (May) Cheng gives us the gift of further insights into the U.S. health system and many issues that the country is debating right now, ranging from health price…

  • Coverage at Work: The Share of Nonelderly Americans with Employer-Based Insurance Rose Modestly in Recent Years, but Has Declined Markedly Over the Long Term 

    News Release

    An improving economy and the Affordable Care Act’s individual mandate may be behind a modest increase in the share of Americans with job-based health insurance in recent years, but the long-term trend remains a downward one, according to a new KFF analysis. Data from the federal National Health Interview Survey show the share of the nonelderly population covered by workplace plans rose from 56.3 percent in 2013 to 58.4 percent in 2017. That was still…

  • An Overview of State Approaches to Adopting the Medicaid Expansion

    Issue Brief

    State approaches to adopting the Affordable Care Act’s Medicaid expansion have varied greatly by state based on state law, the political context, or other factors. While it does not cover how every state has enacted the Medicaid expansion, this issue brief highlights some of the different approaches states have taken to adopt the Medicaid expansion. Each state’s circumstances are unique, and the actions taken by one state may not apply to another state’s circumstances.

  • “Partial Medicaid Expansion” with ACA Enhanced Matching Funds: Implications for Financing and Coverage

    Issue Brief

    The Affordable Care Act (ACA) provides enhanced federal matching funds to states that expand Medicaid to nonelderly adults up to 138% of the federal poverty level (FPL, $17,236/year for an individual in 2019). The ACA enhanced match (93% in 2019, and 90% in 2020 and thereafter) is substantially higher than states’ traditional Medicaid matching rate. A few states have sought Section 1115 demonstration waiver authority from the Centers for Medicare and Medicaid Services (CMS) to…

  • Health Care Spending is More Than Just the Parts You See

    From Drew Altman

    In this Axios column, Drew Altman looks at total family spending for health including taxes and health benefits, and why people need to understand it to assess proposals like Medicare-for-All.