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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

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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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  • 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 Will Uninsured Childless Adults Be Affected By Health Reform?

    Issue Brief

    This brief examines uninsured childless adults and how they could be affected by health reform, including estimates of how many might qualify for coverage under a Medicaid expansion, how many would be eligible for subsidies and how many would not be eligible for such help. Issue Brief (.pdf)

  • 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…

  • Candidate Policy Plans Resonate More With Democrats. Here’s Why.

    News Release

    As primary election voting approaches, Drew Altman examines whether there is a difference between Democratic and Republican voters when it comes to how much they care about candidates’ policy plans. Read his latest column for The Wall Street Journal’s Think Tank, “Candidate Policy Plans Resonate More With Democrats. Here’s Why.”

  • Facing the Fallout From a King v. Burwell Ruling

    News Release

    With a Supreme Court decision on King v. Burwell looming, Drew Altman's latest column for The Wall Street Journal’s Think Tank plays out the politics of a ruling for the two major parties. All previous columns by Drew Altman are available.

  • 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…

  • What’s at Stake with ACA Repeal?

    Interactive

    This interactive includes a map and tables that highlight the increases in health insurance coverage through Medicaid and the Marketplaces as well as the increased federal funding that resulted from the implementation of the ACA.

  • Media Availability on Senate Health Bill

    Event Date:
    Event

    The Kaiser Family Foundation held a media-only conference call Tuesday, June 27, with key experts to explain the Senate Republican health bill and to answer questions about its implications and the CBO’s scoring of the bill. During the call, Kaiser's experts  answered reporters' questions about the bill’s potential impact and implications, including how premiums, tax credits, and insurer participation in the ACA’s marketplaces could change; how the bill would phase out federal funding for the…