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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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  • Questions about Prescription Drug Importation? KFF Has Answers

    News Release

    With lowering prescription drug costs a top priority for Americans, the Trump Administration, presidential candidates, members of Congress, and several states are proposing to allow the importation of drugs from abroad, chiefly Canada. The idea of allowing drugs to be imported from Canada and other countries is popular with Americans across the political spectrum, but has yet to be implemented due to concerns about safety, and strong opposition from the drug industry. A new KFF…

  • New Survey Finds 68 Percent of Previously Uninsured Adult Californians Gained Coverage Since the ACA’s Implementation

    News Release

    Steep Drops in Problems Paying For and Getting Care among Recently Insured, But Affordability and Access Problems Remain Eligible Latinos Obtained Coverage at Similar Rates as Whites; People Ineligible Due to Immigration Status Now Make Up 41% of Remaining Uninsured   MENLO PARK, Calif. - About two thirds (68%) of previously uninsured Californians have health coverage after the Affordable Care Act's second open enrollment period, and this group is now much more likely to report…

  • 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…

  • 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.