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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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  • KFF Health Security Watch Delaying Health Care to Avoid Cost Common

    Perspective

    While economic challenges facing the country continue and the Supreme Court is deciding the fate of the Affordable Care Act (ACA), May's Health Tracking Poll finds that the problems and concerns related to health care costs and access are wide-spread. A quarter report they have had problems paying medical bills in the past year and six in ten say they have cut corners to avoid health care costs. The survey also finds that health care can…

  • Potential Story Lines from Trump-Era Health Care Cuts

    Perspective

    In his latest column for the JAMA Health Forum, KFF’s Larry Levitt talks about how popular shows like “The Pitt” can make changes to the health care system stemming from this year’s federal tax and budget bill tangible for viewers, and offers some suggested story lines.

  • How Will the Loss of Enhanced Premium Tax Credits Affect Older Adults?

    Issue Brief

    Adults ages 50 to 64 are disproportionately affected by the expiration of ACA enhanced premium tax credits because they make up a large number of Marketplace enrollees and premiums rise with age. Our analysis shows that older enrollees with moderate to higher incomes have been hit hardest.

  • Long-term Services and Supports: A Rebalancing Act

    Event Date:
    Event

    The ongoing debate over the federal budget and deficit reduction presents a balancing act for policymakers, as many compelling interests compete for scarce dollars. But for 10 million older adults and people with disabilities who need long-term services and supports, there is a "rebalancing act" in progress. The aim is to serve more people at home and in the community, and fewer people in institutions. Are there sufficient home- and community-based programs in all states…

  • How do I appeal a Marketplace decision?

    FAQs

    You can request an appeal of any Marketplace decision, including: Your eligibility to buy coverage in the Marketplace Your eligibility for, or the amount of, premium tax credits or cost sharing reductions (for example, a reduction in your premium tax credit amount) Untimely (late) notice from the Marketplace about a decision To start your appeal, review the Marketplace’s decision (called an eligibility notice), which describes the process you should follow. If you have questions about…

  • A Look at Rural Hospital Closures and Implications for Access to Care: Three Case Studies

    Issue Brief

    The number of rural hospital closures has increased significantly in recent years. This trend is expected to continue, raising questions about the impact the closures will have on rural communities’ access to health care services. To investigate the factors that contribute to rural hospital closures and the impact those closures have on access to health care in rural communities, the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute conducted case studies of…

  • Health Reform: An Overview Tutorial

    Interactive

    This tutorial was produced for kaiserEDU.org, a Kaiser Family Foundation website that ceased production in September 2013. The kaiserEDU.org tutorials are no longer being updated but have been made available on kff.org due to demand by professors who are using the tutorials in class assignments. You may search for other tutorials to view on kff.org. To download this or other tutorials, visit the tutorials archive page.  Slides are available for download using the "Download Slides" link within the…

  • Public Opinion on ACA Replacement Plans: Interactive

    Interactive

    This interactive includes nationally representative polls of adults in the U.S. that ask about views of plans to replace the Affordable Care Act. See the interactive table for variations in question wording as well as the individual polls included.

  • Boomers Come of Age: Covering Early Retirees and Other 50-64 Year-Olds

    Event Date:
    Event

    The Patient Protection and Affordable Care Act contains provisions that can help workers age 50-64 if they lose their jobs and their employer-sponsored health benefits, such as incentives for employers to maintain retiree benefits. This briefing, cosponsored by the Alliance for Health Reform and AARP, answered many questions about provisions of interests to 50-64 year olds. For more information, please visit Alliance's event page. Speakers for this session: The panel is moderated by Ed Howard…