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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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  • Health Care Affordability and the Uninsured

    Event

    Diane Rowland testified at a hearing on the instability of health coverage before the Health Subcommittee of the U.S. House Committee on Ways and Means. Her testimony discussed the growing share of Americans who are uninsured and without adequate health insurance coverage and highlighted the key characteristics and issues with regard to the uninsured as well as the financial burdens for medical care faced by America's families. Testimony (.pdf)

  • Uninsured Young Adults: A Profile and Overview of Coverage Options

    Issue Brief

    Young adults, age 19-29, have the highest uninsured rate of any age group. Since 29% of the uninsured are young adults, efforts to decrease the overall number of uninsured must address this population. This brief examines health coverage for young adults, as well as their health status, access to care, and the financial burdens they encounter when paying for care. It also provides an overview of public and private approaches to expand health coverage for…

  • Health Care Reform Newsmaker Series: Sen. Max Baucus (D-Mont.)

    Event Date:
    Event

    Sen. Max Baucus (D-Mont.), chairman of the Senate Committee on Finance, appeared as the first guest in a new series of Health Care Reform newsmaker briefings sponsored by the Kaiser Family Foundation, Families USA and the National Federation of Independent Business. The reporters-only briefings, designed to inform the public about prospects and options for health reform, feature a short presentation by an influential leader followed by an extended question-and-answer session. Transcript (.pdf) Video

  • Individuals with Special Needs and Health Reform: Adequacy of Health Insurance Coverage

    Issue Brief

    This issue brief examines the health care needs and health costs of individuals with special health challenges, focusing on those with low-to-moderate incomes. It finds that even under a benefit package more generous than most offered in the private insurance market, individuals and families can face significant gaps in coverage and large out-of-pocket costs, especially if they have serious health conditions. The findings have implications for the health reform debate as policymakers consider minimum standards…

  • Kaiser Poll: Early Reaction to Supreme Court Decision on ACA

    Perspective

    Following last week's Supreme Court's decision upholding the heart of the Affordable Care Act (ACA), a majority of Americans (56 percent) now say they would like to see the law's detractors stop their efforts to block its implementation and move on to other national problems. In the first of two polls to be released this month looking at opinion on the ACA in the wake of the Court's decision, Democrats overwhelmingly say opponents should move…

  • 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.

  • Matching Health Benefit Packages to Health Needs: Key Issues To Consider In Health Reform

    Event Date:
    Event

    Three reports and a video collectively examine the range of health care needs and costs that people face today against the backdrop of the scope of health coverage that may be available to them under health reform. Children and Health Care Reform: Assuring Coverage That Meets Their Health Care Needs and Individuals With Special Needs and Health Reform: Adequacy of Health Insurance Coverage examine the needs of children and adults, respectively, focusing on those with…