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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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  • Universal Coverage May Not Mean Everyone Has Health Insurance

    From Drew Altman

    Universal coverage is a big and important goal. But would absolutely everyone be covered under current proposals? Is it a better rallying cry for Democrats in the primaries or the general election? Drew Altman analyzes these questions in an Axios column.

  • About 1 in 6 Emergency Visits and Hospital Stays Had At Least One Out-of-Network Charge in 2017

    News Release

    In roughly 1 of every 6 emergency room visits and inpatient hospital stays in 2017, patients came home with at least one out-of-network medical bill, a new KFF analysis finds. More specifically, 18 percent of all emergency visits and 16 percent of in-network hospital stays had at least one out-of-network charge, leaving patients at risk for surprise medical bills, according to the analysis of claims data from large employer plans. The analysis also finds the…

  • 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…

  • 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.

  • Poll: As Midterms Approach, Health Care Remains Voters’ Top Issue, But President Trump and Other Factors Also Loom Large

    News Release

    Most Florida Voters Favor Expanding Medicaid in their State, As Do Voters across All Non-Expansion States In an expansive look at the role issues and politics may play in the 2018 midterm elections, the latest KFF Health Tracking Poll continues to find health care as the top issue for voters, but large shares of voters also say candidate characteristics, President Trump, and party control over Congress will be major factors. In the last KFF tracking…

  • How Repeal of the Individual Mandate and Expansion of Loosely Regulated Plans are Affecting 2019 Premiums

    Issue Brief

    In health insurance systems designed to protect people with pre-existing conditions and guarantee availability of coverage regardless of health status, countervailing measures are also needed to ensure people do not wait until they are sick to sign up for coverage (as doing so would drive up average costs for other enrollees). The Affordable Care Act (ACA) included a variety of “carrots” (e.g., premium tax credits and cost-sharing reductions) and “sticks” (e.g., the individual mandate penalty…