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The ACA MarketplaceS

How Has Marketplace Enrollment Changed Across States in 2026?

Following several years of rapid enrollment growth in the ACA Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the enhanced tax credits, generally saw lower drops in enrollment.

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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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  • Estimates: Average ACA Marketplace Premiums for Silver Plans Would Need to Increase by 19% to Compensate for Lack of Funding for Cost-Sharing Subsidies

    News Release

    A new Kaiser Family Foundation analysis finds that the average premium for a benchmark silver plan in Affordable Care Act (ACA) marketplaces would need to increase by an estimated 19 percent for insurers to compensate for lost funding if they don’t receive federal payment for ACA cost-sharing subsidies. Established by the health law to reimburse insurers for the cost of reducing out-of-pocket costs for lower-income people buying marketplace plans (with incomes from 100% to 250%…

  • Three Quarters of the Public, Including a Majority of Trump Supporters, Want President Trump to Try to Make the Affordable Care Act Work

    News Release

    Americans See Many Factors Behind AHCA’s Failure, But Few Republicans Blame President Trump Despite divided views about the Affordable Care Act, three-fourths of the public (75%) say President Trump and his administration should do what they can to make the law work, while one in five (19%), including 38 percent of Republicans, say the Administration should do what it can to make the law fail so they can replace it later, the latest Kaiser Health…

  • A Warning From the Polls About Letting Obamacare “Explode”

    From Drew Altman

    In this column for Axios, Drew Altman sees a warning for the Trump administration and Republicans in the latest Kaiser Tracking Poll: the more they do to undermine the Affordable Care Act marketplaces the more the public is likely to hold them, and not the Democrats, accountable for the problems with the law.

  • JAMA Forum: Is the Affordable Care Act Imploding?

    Perspective

    In this April 2017 post, Larry Levitt discusses the current status of the Affordable Care Act's health insurance marketplaces, and explains how the Trump administration's choices -- including whether to continue cost-sharing reduction payments to insurers -- could influence stability of the marketplaces going forward. The post is now available at The JAMA Forum.

  • Why Trump’s Dealmaking Model Doesn’t Fit Health Care Policy

    From Drew Altman

    In this column as an Axios contributor, Drew Altman discusses President Trump's threat to withhold cost sharing subsidies and questions whether his approach to deal making can bridge health care's partisan and ideological divide. "Health policy is not like real estate," he says.

  • The Effects of Ending the Affordable Care Act’s Cost-Sharing Reduction Payments

    Issue Brief

    This analysis estimates that total federal spending on Affordable Care Act marketplace subsidies would rise $2.3 billion, or 23 percent, in 2018 if payments for the cost-sharing reduction program were eliminated and insurers increased premiums to compensate. Established to reduce out-of-pocket costs for marketplace enrollees with lower incomes, the cost-sharing payments are being challenged in a lawsuit from the U.S. House.

  • Data Note: Medicaid Managed Care Growth and Implications of the Medicaid Expansion

    Issue Brief

    Most states today rely heavily on risk-based managed care organizations (MCOs) to serve Medicaid beneficiaries. This Data Note discusses the current role of managed care in Medicaid and examines differences in managed care growth between states that expanded Medicaid to low-income adults under the Affordable Care Act (ACA) and states that did not expand Medicaid.

  • Medicaid Coverage of Pregnancy and Perinatal Benefits: Results from a State Survey

    Report

    This report details findings from a state survey on perinatal benefits in place as of July 1, 2015 for women enrolled in fee-for-service Medicaid through different eligibility pathways, including traditional pre-ACA Medicaid pathways, expansion, and pregnancy-related eligibility for the following services: basic prenatal care, counseling and support services, delivery and postpartum care, and breastfeeding supports.

  • State Variation in Medicaid Per Enrollee Spending for Seniors and People with Disabilities

    Issue Brief

    This issue brief explains the variation in Medicaid spending per enrollee for seniors, nonelderly adults with disabilities, and children with disabilities compared to other populations as well as the variation in per enrollee spending for these populations among states. It also provides a snapshot of state choices about optional eligibility pathways and services important to many seniors and people with disabilities.