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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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  • Kaiser Health Tracking Poll – Late Summer 2018: The Election, Pre-Existing Conditions, and Surprises on Medical Bills

    Feature

    The latest Kaiser Health Tracking Poll continues to find pre-existing conditions as a widespread concern with most Americans saying it is very important that the Affordable Care Act’s (ACA) protections for people with pre-existing conditions remain law. With health care costs continuing to be a major topic in the 2018 campaigns, the poll looks at the public’s experiences with unexpected medical bills and finds that this tops a list of possible problems people could face.…

  • Poll: The ACA’s Pre-Existing Condition Protections Remain Popular with the Public, including Republicans, As Legal Challenge Looms This Week

    News Release

    Public Not Confident in President Trump’s Calls on Drug Companies to Lower Prices As a federal court considers a challenge to the Affordable Care Act’s constitutionality, the public, including most Republicans, wants protections for people with pre-existing conditions preserved, the latest Kaiser Family Foundation tracking poll finds. Large majorities of Americans say it is “very important” to retain the ACA provisions that prevent insurance companies from denying coverage based on a person’s medical history (75%)…

  • 2018 Elections: Key Medicaid Issues to Watch

    Issue Brief

    Medicaid provides health insurance coverage for more than 76 million Americans, supplies funding for safety-net providers, and is the largest source of federal revenues for states. At this time last year, Congress was debating repeal and replace of the Affordable Care Act (ACA) as well as more fundamental changes to Medicaid financing. While federal legislative changes to Medicaid did not pass in 2017, the outcomes of the 2018 elections will shape program changes at both…

  • Enrollment in the Individual Insurance Market Continued to Fall in the First Quarter of 2018, With the 12 Percent Overall Decline Concentrated in Off-Exchange Plans

    News Release

    Enrollment in the individual insurance market continued to shrink in the first quarter of 2018, declining by 12 percent compared to the first quarter of 2017, according to a new analysis from the Kaiser Family Foundation. The decline was concentrated in off-exchange plans where enrollees are not eligible for Affordable Care Act subsidies and have had to pay the full cost of recent premium increases. At the same time, enrollment in plans sold through the…

  • Conversation on Health Care and the 2018 Midterm Elections

    Event Date:
    Event

    Health care ranks among the top issues voters want to hear candidates talk about on the campaign trail, with costs being the most concerning health issue for voters. Meanwhile, the constitutionality of the Affordable Care Act (ACA) continues to be challenged in the judicial system with the latest case potentially jeopardizing the law’s protections for people with pre-existing conditions. And in four states, ACA Medicaid expansion initiatives are on the ballot to newly expand or…

  • Web Briefing for Journalists: Key Issues Ahead of Marketplace Open Enrollment

    Event Date:
    Event

    Marketplace open enrollment, the period during which consumers can shop for health plans or renew existing coverage through the Affordable Care Act’s health insurance marketplaces, begins on Nov. 1. Recent policy changes at the state and federal levels have the potential to impact individuals and families purchasing health insurance for 2019. It’s the first open enrollment period following Congress’ repeal of the ACA’s individual mandate penalty, the requirement that individuals have minimum essential health coverage…

  • Tracking Section 1332 State Innovation Waivers

    Fact Sheet

    This interactive map shows the status of all Section 1332 waivers requested by states. The Affordable Care Act (ACA) allows states to apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets and can be used to shore up fragile insurance markets, address unique state insurance market issues, or experiment with alternative models of providing coverage to state residents.