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Affordable Care Act

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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  • Report and Video Highlight Health Coverage Struggles, Other Economic Concerns of Working Families

    Event Date:
    Event

    This report and video from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU) illustrate the financial struggles of many families in the United States and show the central role of health care costs and coverage in a household's economic stability. The report, Snapshots from the Kitchen Table: Family Budgets and Health Care, is based on interviews with 27 families from six cities across the U.S.. It finds pervasive uncertainty over job security…

  • Spending To Survive: Cancer Patients Confront Holes in the Health Insurance System

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    Event

    This report highlights the severe challenges cancer patient may face in paying for life-saving care even when they have private health insurance. Jointly authored by the Kaiser Family Foundation and the American Cancer Society, the report profiles 20 patients and illustrates the potential difficulties people diagnosed with cancer or other serious illnesses have in maintaining affordable health insurance and paying for their health care. The patients in the report and accompanying video were selected to…

  • Pulling it Together from Drew Altman: Multiple Agendas for Controlling Health Care Costs

    Perspective

    In what would be a domestic policy trifecta, we may be headed for interconnected big debates about economic recovery, entitlement programs and health reform. A core issue in the entitlement and health reform debates is the problem of rising health care costs. President Obama, now apparently fully briefed on the economic, budget and health reform realities he faces, is talking conspicuously about hard choices that may lie ahead. In a short period of time the…

  • Window of Opportunity?

    From Drew Altman

    Beginning this Spring, between expected approval of an economic stimulus package and the start of campaigning for the midterm election, there will be a rare window of opportunity for passage of major health reform legislation. History suggests that momentum can be lost if policymakers do not move quickly to seize these rare openings when they occur. There is an opportunity now because the nation has a popular new president with political capital to burn who…

  • Pulling It Together: The “R” Word Is Back

    Perspective

    Longer ago than I care to admit, I got my start in health policy at M.I.T. when I wrote a book about health care regulation. The book was about a long forgotten attempt to rationalize the health care system through an elaborate health planning program set up in the seventies under the National Health Planning and Resources Development Act. It established a system of federal, state and regional planning bodies to control health care costs by limiting the supply of…

  • Primers on Key Health Care Topics and Programs

    Issue Brief

    The Kaiser Family Foundation maintains a number of primers providing overviews of key health care programs and issues. Written by Foundation staff, each primer provides key data and information that helps illustrate the topic and its relevance for the nation's health care system. Medicaid: A Primer Medicare: A Primer The Uninsured: A Primer Health Care Costs: A Primer How Private Health Coverage Works: A Primer Mental Health Financing in the United States: A Primer The…

  • Health Coverage in a Period of Rising Unemployment

    Issue Brief

    This policy brief reviews the public and private options available to help people maintain coverage if they become unemployed during a downturn and cannot get employer-sponsored coverage through a spouse. Specifically, it examines COBRA, non-group insurance and Medicaid. And it explains why, despite such options, more people will become uninsured as unemployment rises. Recent analysis predicts that each 1 percentage point increase in unemployment will lead to 1.1 million more uninsured adults. Issue Brief (.pdf)

  • Approaches to Covering the Uninsured: A Guide

    Issue Brief

    The guide explains the key strategies for expanding coverage to the nation's 45 million uninsured people and explains and how different policy options can be combined to form comprehensive reform proposals. It organizes the various policy strategies under four overall approaches: strengthening current coverage arrangements, improving the affordability of coverage, improving the availability of coverage and changing the tax treatment and financing of health insurance. Guide (.pdf)

  • Pulling It Together: Keeping the Health Reform Coalition Together

    Perspective

    We could be headed for a new schism in the debate about health reform. Not the familiar gulf between advocates of the market and government, or the predictable one between deficit hawks and spenders, but a new one that crosses traditional partisan and ideological lines between advocates of long-term reform of the health care delivery system, and immediate help for the uninsured and insured struggling with health care costs.  This new rift is most likely to develop if tight money and a crowded agenda…

  • Health Coverage in an Economic Downturn: Impact of Tight Budgets on Families and States

    Fact Sheet

    The economic downturn has strained family finances and prompted some Americans to cut back on medications and forgo preventive care and visits to the doctor. At the same time, the downturn has triggered declines in tax revenue that inhibit states’ ability to meet rising Medicaid program costs as enrollment spikes during economic hard times. Many states are expected to struggle to close budget gaps despite moves by Congress and the Obama Administration to temporarily boost…