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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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  • 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.

  • Brief Examines State Requests to Impose Work Requirements in Medicaid

    News Release

    The proposed American Health Care Act (AHCA) includes a state option to make Medicaid eligibility for nondisabled, nonelderly, non-pregnant adults conditional upon satisfaction of a work requirement. Although the Centers for Medicare and Medicaid Services denied all state Section 1115 waiver requests to institute such work requirements under the Obama administration, earlier this month the Trump administration signaled in a letter to governors that CMS now would be open to considering such proposals. A new…

  • 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…

  • Implementing Health Reform in the States

    Event Date:
    Event

    The Alliance for Health Reform, Robert Wood Johnson Foundation and the Association of Health Care Journalists sponsored this live webinar on March 27, 2012, to take a look at what's happening in the states with implementation of the Patient Protection and Affordable Care Act. Many of the key decisions implementing the health reform law are left to the states. For example, states have leeway in how they set up health insurance exchanges, where uninsured individuals…

  • The Left is Getting More Active on Health Care

    From Drew Altman

    In this Axios column, Drew Altman discusses data from the new KFF/Washington Post survey on activism in America showing the role support for the ACA is playing in motivating political participation, and how, in a reversal from the last election cycle, political energy is shifting from right to left on health care as a new election looms.

  • KFF April Tracking Poll: Opinions of Reform Remain Steady

    Perspective

    This month, public opinion on the health reform law continues to be remarkably steady. The April Kaiser Health Tracking Poll finds that four in ten feel favorably about the law and an equal share say they feel unfavorably. In recent months there has been a slight decline in the share with an unfavorable view of the law, with a corresponding uptick in the share who offer no opinion on the law. The rise in those…

  • How Many Employers Could Be Affected by the High-Cost Plan Tax

    Issue Brief

    The high cost plan tax (HCPT) sometimes referred to as the Cadillac tax, is an excise tax on the cost of employer health benefit exceeding certain threshold. The HCPT provides a powerful incentive to control health plans costs over time, whether through efficiency gains or shifts in costs to workers. While many employers do not expect that the tax will take effect in 2022, others are already amending their health programs in anticipation. We estimate…