Affordable Care Act

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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  • What’s Really At Stake In the Medicaid Spending Debate

    From Drew Altman

    In this Axios column, Drew Altman highlights that the federal debate about the American Health Care Act’s Medicaid spending reductions will ultimately be a debate about every state’s general budget spending priorities, as states discuss whether to offset reductions in federal revenues with some combination of cuts to their Medicaid programs, increased taxes, and cuts to spending in other areas.

  • The Republican Base is Getting Less Excited About Health Care

    From Drew Altman

    In this Axios column, Drew Altman explains that as Republican policymakers are focused on delivering a repeal of Obamacare for their base, polling shows that it’s not a top priority for Trump supporters, and their intensity on a replacement plan has declined, suggesting that the issue may not drive turnout for future elections.

  • Out-of-pocket spending on insulin among people with private insurance

    Issue Brief

    This analysis of insurance claims data finds that Congressional proposals to set a $35 per month cap on what people pay out of pocket for insulin would provide financial relief to at least 1 out of 5 insulin users with different types of private health insurance.

  • Visualizing Health Policy: Preventive Services for Women and the Affordable Care Act

    News Release

    This month’s Visualizing Health Policy infographic takes a look at preventive health services for women, including missed opportunities for preventive counseling on risk factors (such as smoking or alcohol) and sexual health issues (such as contraception, sexually transmitted infections, and domestic violence), the effects of lack of insurance on rates of mammograms and other screening tests for women, and how costs are a barrier that cause some women to postpone preventive services or skip a…

  • New Analysis Provides Early Look At Increase in Individual Market Enrollees 

    News Release

    A new Kaiser Family Foundation analysis of health insurer reports to state regulators provides a first glimpse of enrollment in the individual, or non-group, insurance market under the Affordable Care Act.  These initial filings reflect enrollment both through the new state insurance marketplaces created under the Affordable Care Act as well as through off-exchange plans. The analysis suggests a net increase from the end of 2013 of about 3 million to 3.5 million people with…

  • Potential Supreme Court Decision: Who Will Bear the Coverage “Burdens?”

    Issue Brief

    The Supreme Court is expected to reach a decision by the end of June, 2014 on the cases brought forth by Hobby Lobby and Conestoga Wood Specialties, two for profit corporations challenging the ACA’s contraceptive coverage requirement. The plaintiffs contend that the requirement that they include coverage for certain contraceptive services (emergency contraceptive pills and intrauterine devices) in the insurance plans “substantially burdens” both the corporation’s and the owners’ religious rights. During the arguments, several…

  • The Politics of ACA Rate Hikes Will Be 2016 in Reverse

    From Drew Altman

    Democrats are expected to turn the tables and attack Republicans for rising premiums and sabotaging the Affordable Care Act. In his Axios column, Drew Altman discusses a balancing act they face which has not received attention: score political points, but run the risk of a new debate scaring the broader public and undermining the ACA by focusing on its continuing problems.

  • KFF March Health Tracking Poll: One Year Later, Views on Health Reform Remain Divided

    Perspective

    Health reform is a year old and the latest Kaiser Health Tracking Poll finds a basic division that has changed little during the last 12 months. This month, 42 percent of Americans hold favorable views of the law while 46 percent view it unfavorably. In April 2010, the month after passage, 46 percent had favorable views and 40 percent unfavorable ones, but both figures have ticked up and down over the last year. Opinion of…