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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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  • Brief Examines State Requests to Impose Work Requirements in Medicaid

    News Release

    The proposed American Health Care Act (AHCA) includes a state option to make Medicaid eligibility for nondisabled, nonelderly, non-pregnant adults conditional upon satisfaction of a work requirement. Although the Centers for Medicare and Medicaid Services denied all state Section 1115 waiver requests to institute such work requirements under the Obama administration, earlier this month the Trump administration signaled in a letter to governors that CMS now would be open to considering such proposals. A new…

  • Would States Eliminate Key Benefits if AHCA Waivers are Enacted?

    Issue Brief

    This analysis offers a window into how insurers could respond if the Affordable Care Act's essential health benefits requirement is rolled back, a change being considered by Congressional leaders and allowed through state waivers by the House-passed American Health Care Act as a potential way for lowering premiums.

  • President Obama’s Campaign Position on Health Reform and Other Health Care Issues

    Issue Brief

    During the 2008 Presidential campaign now President Barack Obama announced a comprehensive health care reform proposal and laid out his positions on a number of other key health care issues. The two documents below summarize these campaign policies and positions. They were prepared by the Kaiser Family Foundation with the assistance of Health Policy Alternatives, Inc., and are based on information compiled from Obama's campaign Web site, speeches, campaign debates and news reports. They are…

  • Boomers Come of Age: Covering Early Retirees and Other 50-64 Year-Olds

    Event Date:
    Event

    The Patient Protection and Affordable Care Act contains provisions that can help workers age 50-64 if they lose their jobs and their employer-sponsored health benefits, such as incentives for employers to maintain retiree benefits. This briefing, cosponsored by the Alliance for Health Reform and AARP, answered many questions about provisions of interests to 50-64 year olds. For more information, please visit Alliance's event page. Speakers for this session: The panel is moderated by Ed Howard…

  • Strengthening Medicaid with Health Information Technology: Are Providers & States Up to the Challenge?

    Event Date:
    Event

    Health care providers can receive Medicare and Medicaid payment incentives when they adopt electronic health records and demonstrate their "meaningful use." Additionally, states must establish a website by 2014 for Medicaid beneficiaries to electronically enroll and renew coverage. Yet many challenges remain so that health information technology (HIT) can help the Medicaid program operate more effectively. How can Medicaid health plans and providers use HIT to provide better care delivery and improve health outcomes while…

  • Explaining Health Care Reform: Questions About Health Insurance Exchanges

    Issue Brief

    The Patient Protection and Affordable Care Act (PPACA), signed into law in March 2010, made broad changes to the way health insurance will be provided and paid for in the United States. PPACA created a new mechanism for purchasing coverage called Exchanges, which are entities that will be set up in states to create a more organized and competitive market for health insurance by offering a choice of health plans, establishing common rules regarding the…

  • Implementing Health Reform in the States

    Event Date:
    Event

    The Alliance for Health Reform, Robert Wood Johnson Foundation and the Association of Health Care Journalists sponsored this live webinar on March 27, 2012, to take a look at what's happening in the states with implementation of the Patient Protection and Affordable Care Act. Many of the key decisions implementing the health reform law are left to the states. For example, states have leeway in how they set up health insurance exchanges, where uninsured individuals…

  • 2021 Calculator – Before COVID-19 Relief

    Interactive

    The Health Insurance Marketplace Calculator, updated with 2021 premium data, provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA). With this calculator, you can enter your income, age, and family size to estimate your eligibility for subsidies and how much you could spend on health insurance.

  • The Left is Getting More Active on Health Care

    From Drew Altman

    In this Axios column, Drew Altman discusses data from the new KFF/Washington Post survey on activism in America showing the role support for the ACA is playing in motivating political participation, and how, in a reversal from the last election cycle, political energy is shifting from right to left on health care as a new election looms.

  • KFF April Tracking Poll: Opinions of Reform Remain Steady

    Perspective

    This month, public opinion on the health reform law continues to be remarkably steady. The April Kaiser Health Tracking Poll finds that four in ten feel favorably about the law and an equal share say they feel unfavorably. In recent months there has been a slight decline in the share with an unfavorable view of the law, with a corresponding uptick in the share who offer no opinion on the law. The rise in those…