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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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  • Medicaid Beneficiaries and Access to Care

    Fact Sheet

    The health reform law relies on a large expansion of Medicaid to reach many low-income uninsured people, many of them adults. This fact sheet summarizes Medicaid beneficiaries' experience in obtaining access to care, a subject that is of keen interest in view of the planned expansion of the program. Medicaid and the Children's Health Insurance Program have substantially increased coverage among low-income Americans, especially children. Research shows that Medicaid compares favorably with private coverage in…

  • Resources on Community Health Centers

    Fact Sheet

    The Kaiser Family Foundation has issued three new resources that examine the role of community health centers as key components of the U.S. health care system, providing primary care to more than 16 million patients nationwide in 2007. The documents, produced for the Kaiser Commission on Medicaid and the Uninsured, include a fact sheet on community health centers, an updated issue brief on their role in the health system and a report on how such…

  • State Budgets Under Federal Health Reform: The Extent and Causes of Variations in Estimated Impacts

    Issue Brief

    This analysis examines the potential costs and savings that the health reform law may generate for state budgets, a topic of great interest at a time when states continue to struggle with tight budgets in the wake of the recession. The analysis seeks to explain why recent state estimates of the likely impact of health reform on their budgets vary widely, and discusses the major expected sources of costs and savings as the new law…

  • Medicaid and CHIP Health Reform Implementation Timeline

    Issue Brief

    This timeline highlights the implementation dates for provisions in the new health reform law that are related to Medicaid and the Children's Health Insurance Program. While major expansions of Medicaid are set to occur in 2014, many other key provisions in the health reform law become effective between 2010 and 2014. Timeline (.pdf)

  • What People Don’t Realize About the Affordable Care Act

    From Drew Altman

    Drew Altman, in The Wall Street Journal’s Think Tank, discusses what people don’t realize about the ACA: it is engineered for variation and it is up to Congress and the states to learn from that variation.

  • 2025 KFF Marketplace Enrollees Survey

    Poll Finding

    This survey explores how ACA Marketplace enrollees expect to respond if their premium payments doubled as expected in 2026 when enhanced premium tax credits are set to expire. About a third would very likely look for a lower-cost plan, even if it had higher deductibles, and about a quarter would very likely end up uninsured. The survey also examines how increased health care costs may affect their finances and the potential impact in next year's…

  • 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…