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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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  • What Will Candidates Say About Medicare This Election?

    Perspective

    In this article for the American Society of Aging’s Generations Today, KFF Senior Vice President Tricia Neuman examines what President Trump and former Vice President Joe Biden are saying about key issues for Medicare beneficiaries, including drug prices and affordability, as well as what they aren’t saying about Medicare’s financing.

  • Affordability in the ACA Marketplace Under a Proposal Like Joe Biden’s Health Plan

    Issue Brief

    This 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. Biden's plan would, however, increase federal spending, which we do not attempt to estimate here.

  • Is COVID-19 a Pre-Existing Condition? What Could Happen if the ACA is Overturned

    Policy Watch

    If the ACA is overturned, federal law protection for people with pre-existing health conditions would end.  This post examines what that could mean for people in the time of COVID-19, including whether and how insurers could deny coverage to people who have had COVID or other pre-existing conditions.

  • Loss of the Affordable Care Act Would Widen Racial Disparities in Health Coverage

    Policy Watch

    In November, the Supreme Court is scheduled to hear arguments on a legal challenge that seeks to overturn the Affordable Care Act (ACA). This analysis shows that new coverage options under the ACA have contributed to large gains in coverage, particularly among people of color, helping to narrow longstanding racial disparities in health coverage.

  • Surprise Medical Bills are Ending, But Controversy Continues

    Perspective

    In this column for the JAMA Health Forum, Larry Levitt examines how the No Surprises Act that prohibits unexpected out-of-network charges for patients could lead to lower payment rates and revenues for some doctors and other care providers.

  • People With HIV in Non-Medicaid Expansion States: Who Could Gain Coverage Eligibility Through Build Back Better or Future Expansion?

    Issue Brief

    In this analysis, we explore the implications of the Build Back Better Act's current coverage provisions for people with HIV in select non-expansion states. We estimate the size of the population that could gain eligibility as well as their socio-demographic characteristics, examine their affordability barriers and assess the potential impact on the Ryan White HIV/AIDS Program. We also explore what Medicaid expansion could mean in these non-expansion states for people with HIV.

  • Supplemental Security Income for People with Disabilities: Implications for Medicaid

    Issue Brief

    This issue brief describes key characteristics of SSI enrollees, explains the SSI eligibility criteria and eligibility determination process, and considers the implications of changes in the SSI program for Medicaid, including the effects of the COVID-19 pandemic and resulting economic downturn as well as proposals supported by President Biden that Congress might consider.