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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

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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  • Uwe Reinhardt’s New Book Priced Out: His Health Policy Ideas in Today’s Debates

    Event Date:
    Event

    Dr. Uwe Reinhardt is a giant in the health policy field who advised policymakers and influenced debates about the nation’s health system before his passing in 2017. His recently released last book, Priced Out: The Ethics and Economics of Health Care, completed by his wife and longtime collaborator Tsung-Mei (May) Cheng gives us the gift of further insights into the U.S. health system and many issues that the country is debating right now, ranging from health price…

  • Analysis: ‘Cadillac Tax’ on High-Cost Health Plans Could Affect 1 in 5 Employers in 2022

    News Release

    A new KFF analysis estimates that the Affordable Care Act’s tax on high-cost health plans would affect one in five (21%) employers offering health benefits when it takes effect in 2022 unless employers change their health plans. An even larger share (31%) could be affected when workers’ voluntary contributions to Flexible Spending Accounts are taken into account. The analysis comes as some in Congress are proposing to repeal the ACA’s tax on high-cost health plans,…

  • State Actions to Improve the Affordability of Health Insurance in the Individual Market

    Issue Brief

    A number of states have taken steps to provide consumers with more affordable coverage options in the individual market, including the marketplaces. Some states are implementing strategies that lower premiums by building on, and increasing the stability of the individual market, while other states are expanding the availability of lower cost coverage sold outside the marketplaces that does not comply with ACA standards—an approach that could increase marketplace premiums further. This brief examines these different…

  • From Ballot Initiative to Waivers: What is the Status of Medicaid Expansion in Utah?

    Issue Brief

    The Utah legislature significantly changed and limited the Medicaid coverage expansion that was adopted by the voters through a ballot initiative in November 2018. This issue brief explains new provisions in Utah's recently amended Section 1115 Medicaid waiver and the additional amendments that the state has submitted to CMS, including most recently a request for enhanced ACA federal matching funds for an expansion to 138% FPL with an enrollment cap.

  • KFF Poll: Public Opinion and Knowledge on Reproductive Health Policy

    Poll Finding

    The latest KFF Poll examines the public’s attitudes towards different facets of reproductive health care in light of recent policy changes made by the Trump administration. This poll examines attitudes towards major changes to the Title X program and attitudes toward state-level laws restricting abortions after a fetal heartbeat has been detected. The poll also looks at public awareness of provisions related to women’s health that are part of the 2010 Affordable Care Act.

  • Poll Finds Most Americans Oppose the Trump Administration’s Changes to Restrict Title X Family Planning Funds from Clinics that also Provide or Refer for Abortion

    News Release

    A new KFF poll of the public’s views on reproductive health issues finds most Americans, including majorities of women of reproductive age, are concerned that access to women’s reproductive health and preventive care services may be limited by the Trump administration’s changes to Title X, the nation’s federal family planning program. The poll examines the public’s views of major regulatory changes to the Title X program, which funds nearly 4,000 clinics nationally to pay for…

  • The Silent Affordability Crisis Facing Sick People

    From Drew Altman

    In this Axios column, Drew Altman shows that employer coverage for lower wage workers is much worse than ACA marketplace coverage for similar populations. It’s a bigger problem we need to talk about more, he says.

  • Health Care Spending is More Than Just the Parts You See

    From Drew Altman

    In this Axios column, Drew Altman looks at total family spending for health including taxes and health benefits, and why people need to understand it to assess proposals like Medicare-for-All.

  • Poll: Nearly 1 in 4 Americans Taking Prescription Drugs Say It’s Difficult to Afford Their Medicines, including Larger Shares Among Those with Health Issues, with Low Incomes and Nearing Medicare Age

    News Release

    As the Trump Administration and Congress weigh policy options to address high prescription drug prices, a fourth of people taking prescription drugs (24%) and seniors taking drugs (23%) say it is difficult for them to afford their medications, the latest KFF Health Tracking Poll finds. The groups most likely to report difficulties affording their medications include people with monthly drug costs of $100 or more (58%), in fair or poor health (49%), with annual incomes less than $40,000 (35%),…

  • Poll: Most Americans Say HIV Is Serious Issue for the Country as Trump Administration Rolls Out New Plan to End HIV by 2030; Black and Hispanic Adults Report More Personal Concern than White Adults

    News Release

    Support for Medicare-for-all Holds Steady With the Trump administration launching a new domestic HIV effort, the latest KFF Health Tracking Poll finds a large majority of Americans (80%) view the HIV epidemic as a serious national issue, including a third (34%) who view it as “very serious.” Nearly half (46%) view it as a serious concern for people they know, including a quarter (24%) who view it as “very serious.” The poll is the first to…