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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.

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

About the ACA

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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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  • Keeping Coverage Continuous: Smoothing the Path between Medicaid and the Exchange

    Event Date:
    Event

    A key challenge for those implementing the reform law is how to manage churning, when people cycle in and out of public programs as their income varies. What approaches are states and the federal government taking to minimize the disruption from churning? Will people be able to keep their provider as they move from Medicaid to private coverage and back? This briefing, sponsored by the Alliance for Health Reform and The Commonwealth, addressed these and…

  • California and Texas: Section 1115 Medicaid Demonstration Waivers Compared

    Fact Sheet

    This fact sheet compares and contrasts key provisions of the California and Texas Section 1115 Medicaid demonstration waivers. The Texas waiver, approved in December 2011, is modeled, in part, on the California waiver, which has been underway in that state since November 2010. Both waivers affect hundreds of thousands of Medicaid beneficiaries, involve billions of federal Medicaid matching funds, and are designed, in part, to promote changes in the health care delivery system that will…

  • Medicaid’s New “Health Home” Option

    Issue Brief

    This brief provides key information about the new option for state Medicaid programs to provide "health home" services for enrollees with chronic conditions. The option, established under the new health reform law, took effect on Jan. 1, 2011. Health homes are designed to facilitate access to and coordination of the full array of primary and acute physical health services, behavioral health care and long-term community-based services and supports. Brief (.pdf)

  • Health Care Costs Top the Public’s List of Financial Worries, and Those Who Are Struggling the Most Want to Hear Presidential Candidates Discuss Economic and Health Care Issues

    News Release

    At a time when kitchen table economic problems are on voters’ minds, unexpected medical bills and health care costs top the public’s list of financial concerns, and voters who are struggling to pay their monthly bills are the most eager to hear the presidential candidates talk about economic and health care issues, the latest KFF Health Tracking Poll finds. Nearly 3 in 4 adults say they are worried about being able to afford unexpected medical…

  • Report Finds State Costs of Implementing The Affordable Care Act’s Medicaid Expansion Would Be Modest Compared to Increases in Federal Funds, and Some States Would See Net Savings

    News Release

    Washington, D.C. – A new report released today by the Kaiser Family Foundation shows modest state costs for implementing the Medicaid expansion under the Affordable Care Act compared to significant increases in federal funds, allowing some states to see net budget savings even as millions of low-income uninsured Americans gain health coverage. The new, updated analysis, conducted by John Holahan, Matt Buettgens, Caitlin Carroll and Stan Dorn at the Urban Institute for the Foundation's Commission…

  • Testimony: State-Based Health Reform Efforts

    Event

    On June 16, 2008, Kaiser Family Foundation Vice President Gary Claxton testified about state-based health reform efforts as part of the Senate Finance Committee's Preparing For Launch Health Reform Summit. In his prepared testimony, he examined the role of Medicaid and the State Children's Health Insurance Program, as well as the way various federal laws and policies may limit innovation at the state level. Testimony (.pdf)