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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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  • Analysis: A Proposal Like Biden’s Health Plan Would Lower the Cost of ACA Marketplace Coverage for Nearly All Potential Enrollees and Lower Premiums for Over 12 Million Workers With Employer Coverage

    News Release

    A new KFF analysis finds that expanding Affordable Care Act (ACA) premium subsidies like Democratic presidential nominee Joe Biden has proposed would lower the cost of Marketplace coverage for nearly all potential enrollees, including the uninsured and others currently priced out of the Marketplace. While the former Vice President’s plan to create a public option has received substantial public attention, his companion proposal to expand ACA marketplace subsidies has been less discussed, even as it…

  • Eliminating the ACA: What Could It Mean for Medicaid Expansion?

    Policy Watch

    The debate over filling the Supreme Court seat previously held by Ruth Bader Ginsburg has brought renewed attention to the possibility of the Affordable Care Act (ACA) being overturned under the court challenge in California v. Texas, currently scheduled to be heard shortly after the election this November. The expansion of Medicaid was a central component of the ACA, and 39 states have now adopted the ACA expansion into their Medicaid programs. Because Medicaid is…

  • A Court Ruling Striking Down the ACA Would Eliminate the Medicaid Expansion and Cause Millions of Low-Income People to Become Uninsured

    News Release

    Millions of low-income Americans currently covered by Medicaid likely would become uninsured if the Supreme Court were to strike down the Affordable Care Act in California v. Texas, a legal challenge the high court is scheduled to hear in early November, KFF experts explain in a new Policy Watch post. Overturning the ACA would eliminate the expansion of Medicaid, which largely has been financed by the federal government, and eliminate eligibility for Medicaid for low-income…

  • Pre-existing Conditions: What Are They and How Many People Have Them?

    Policy Watch

    Facing a challenge now before the Supreme Court, the Affordable Care Act (ACA) included provisions to protect people with pre-existing conditions from discrimination in the individual employment market. This post explains what pre-existing conditions are and the different estimates for the number of people who have them.

  • Protecting People With Pre-Existing Conditions Isn’t As Easy As It Seems

    Policy Watch

    With the death of Justice Ruth Bader Ginsburg, a lawsuit before the Supreme Court to overturn the Affordable Care Act (ACA) suddenly has a much better chance of succeeding. And, that could make protections for people with pre-existing conditions an even bigger campaign issue.

  • The Implications of the Most Recent Challenge to the ACA’s Preventive Care Requirement Could Affect Millions

    News Release

    A new brief explains the implications of the most recent legal challenge contesting the Affordable Care Act’s (ACA) requirement that most private insurance plans cover specific preventive care items and services—such as contraceptive services and supplies, and cancer screenings—at no cost to patients. In Braidwood Management v. Becerra, two Christian-owned businesses and six individuals in Texas have challenged the legality of the preventive care mandates on constitutional grounds. The plaintiffs are also challenging the requirement…

  • Nine Changes to Watch in ACA Open Enrollment 2023

    Policy Watch

    The 2023 Affordable Care Act (ACA) Open Enrollment period will run from November 1, 2022 to January 15, 2023 in most states, longer in some state-based marketplaces. This policy watch examines nine changes that may affect what enrollees pay for coverage, the size of tax credits for those eligible, and other changes that could affect enrollees' experiences.

  • 2022 Health Insurance Marketplace Calculator

    Interactive

    The Health Insurance Marketplace Calculator, updated with 2022 premium data, provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA).