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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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  • The Public and the Health Care Delivery System — Toplines

    Poll Finding

    These toplines from a survey by NPR and researchers at the Kaiser Family Foundation and the Harvard School of Public Health highlight the public's attitudes and experiences with the American health care delivery system. The new survey sheds light on Americans' experiences with issues more typically discussed by health policy experts –- including electronic medical records, coordination of care and comparative effectiveness –- all of which have become serious components of reform plans and some…

  • Health Affairs Article: Comparing the Assets of Uninsured Households to Cost Sharing Under High Deductible Health Plans

    Issue Brief

    Health Affairs Article: Comparing the Assets of Uninsured Households to Cost Sharing Under High Deductible Health Plans Relatively few uninsured households have enough financial assets to cover the cost-sharing in consumer-driven health plans tied to Health Savings Accounts (HSAs), according to this study by Kaiser Family Foundation researchers published as a Health Affairs Web Exclusive on April 15, 2008. Consumer-driven plans generally require enrollees to pay for most health-care expenses themselves until they reach the plan’s relatively high…

  • The Coverage and Cost Impacts of Expanding Medicaid

    Report

    This paper quantifies the impacts on coverage and cost of expanding Medicaid to cover more of the low-income uninsured, including adults, at various income levels and with improved participation rates. The analysis models two primary options to expand Medicaid (250% FPL for children, 100% FPL for adults; 300% FPL for children, 150% for adults) as well as the same options with no change for children. Report (.pdf)

  • Pulling it Together: A Note on Presidential Leadership Strategy

    Perspective

    In inside circles of the health reform debate there has been criticism of the President for not weighing in earlier and publicly on the details of health reform legislation. Does he want the Senate's approach to employer obligations, or the approach taken in the House? What form of public option does he want: a robust one, a trigger, an opt-in, an opt-out, or none at all? What level of premiums and cost sharing is he…

  • Explaining Health Care Reform: Questions About Medicaid’s Role

    Issue Brief

    Medicaid plays a major role in covering more of the uninsured under the new health reform law. The new law includes a significant expansion of Medicaid, an individual requirement to obtain health insurance, and subsidies to help low-income individuals buy coverage through newly established Health Benefit Exchanges. This brief explains the how Medicaid works today and answers some key questions about Medicaid’s role in health reform. Issue Brief (.pdf)

  • Prescription Drug Trends Fact Sheet – May 2010 Update

    Fact Sheet

    This updated fact sheet provides trend information about prescription drug expenditures and coverage, key factors that contribute to rising prescription spending, and efforts to contain rising drug costs. May 2010 Fact Sheet (.pdf)