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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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  • Costs, Coverage, and Enrollment Changes: Exploring Current Public Opinion and Policy on the ACA Marketplaces

    Event Date:
    Event

    Following the expiration of the enhanced premium tax credits at the end of 2025, many Americans enrolled in the ACA Marketplaces have faced higher health care costs and reconsidered their coverage options given affordability concerns. To learn more, join KFF public opinion and policy experts for a virtual event focused on the key issues facing ACA Marketplace enrollees and policy considerations, particularly as health care cost and coverage issues rise to the top of voters’…

  • 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…

  • 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)

  • The Cost of the Individual Mandate Penalty for the Remaining Uninsured

    Issue Brief

    This analysis provides estimates of the share of uninsured people eligible to enroll in the Affordable Care Act marketplaces who will be subject to the individual mandate penalty, and how those penalties are increasing for 2016. It also provides estimates of the number of people who could have a zero-dollar contribution or pay less for health insurance than the penalty, due to premium subsidies, and the number of people who would pay more for a…