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Affordable Care Act

The ACA MarketplaceS

How Has Marketplace Enrollment Changed Across States in 2026?

Following several years of rapid enrollment growth in the ACA Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the enhanced tax credits, generally saw lower drops in enrollment.

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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  • KFF Health Tracking Poll: Public Weighs in on Health Care Debate and Government Shutdown 

    Poll Finding

    This poll finds that public support remains high for extending the enhanced ACA tax credits set to expire at the end of the year. Three quarters of the public favor of extending them, though support among Republicans has dipped since September. Most Democrats want a Congressional budget deal to include an extension of the tax credits.

  • How Affordability of Employer Coverage Varies by Family Income

    Issue Brief

    This analysis looks at the share of family income people with employer-based coverage pay toward their premiums and out-of-pocket payments for medical care. The cost of employer sponsored health insurance—including premiums, deductibles, and other out-of-pocket costs—has risen steadily over time.

  • Health Reform Opportunities: Improving Policy for Dual Eligibles

    Issue Brief

    As the nation considers national health reform, this brief provides an overview of opportunities to realign federal and state policy for the dual eligibles to promote a more rational, cost-efficient system for 9 million of the poorest, sickest and highest-cost people covered by both Medicaid and Medicare. Navigating two programs with different rules and financing incentives is complex for beneficiaries and providers, impedes efforts to improve care coordination and results in cost-shifting between programs that…

  • Kaiser Health Tracking Poll – July 2009

    Poll Finding

    The July Kaiser Health Tracking Poll finds a majority of the public remains supportive of taking action on health reform now, though there is some softening of support as criticisms and doubts seem to be registering. As has been the case over the past ten months, a majority of the American people continue to believe that health reform is more important than ever despite the country's economic problems, and the public believes by a two…

  • Consumers’ Experience in Massachusetts: Lessons For National Health Reform

    Report

    This report examines the impact of state health reform efforts on the lives of ordinary people in Massachusetts, including a look at coverage provided by both public programs and private sources. It focuses specifically on people's ability to afford and obtain needed care. Report (.pdf)

  • Children and Health Care Reform: Assuring Coverage That Meets Their Health Care Needs

    Issue Brief

    This issue brief examines the health care needs and health costs of children and analyzes the specific health care needs of two children in particular, including one with serious health challenges. The findings have implications for the health reform debate as policymakers consider minimum standards for coverage, required cost sharing amounts and limits on covered benefits in health plans. Issue Brief (.pdf)

  • Pathways to Payment Innovation in a Post-Health Reform Era

    Event Date:
    Event

    The new health reform law contains a number of changes in the way health care is paid for, particularly in public programs such as Medicare and Medicaid. The Alliance for Health Reform and The Commonwealth Fund sponsored a May 10 briefing which explored topics such as how some health care providers will be paid differently under reform, what effect this might have on payments across the health care system, and how providers are reacting. For…

  • Pulling it Together: Duals: The National Health Reform Experiment We Should Be talking More About

    From Drew Altman

    The Center for Medicare & Medicaid Services (CMS) and 26 states are moving to launch a large scale managed care demonstration project potentially involving millions of the poorest, sickest, most expensive Medicare and Medicaid beneficiaries, the so-called dual eligibles. The experiment is getting more and more attention from policy experts, but with controversial issues like the survival of the Affordable Care Act and converting Medicare to a premium support program grabbing the limelight, it has…

  • Optimizing Medicaid Enrollment: Spotlight on Technology – Oklahoma’s Automatic Newborn Enrollment System

    Issue Brief

    This brief examines Oklahoma's web-based system for automatically enrolling in its Medicaid program, SoonerCare, and provides an overview of the state's more recent implementation of an online SoonerCare application for children and families, pregnant women, and other adults. It is the fourth brief in a Spotlight on Technology series profiling several states' innovative applications of technology to Medicaid enrollment efforts. The series illustrates a range of approaches that states can adopt to improve their systems…