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.

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

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: ACA Enhanced Subsidies

    Feature

    KFF's Health Tracking Poll looks at public awareness and support for ACA Marketplace subsidies and finds that most adults are unaware the subsidies are set to expire soon. Three in four say Congress should extend the subsidies and support persists despite hearing counter arguments.

  • Poll: Most of the Public Support Extending the ACA’s Enhanced Premium Tax Credits, Including Most Republicans and MAGA Supporters

    News Release

    With the Affordable Care Act’s (ACA) enhanced premium tax credits set to expire at the end of 2025, a large majority (77%) of the public favor Congress extending the credits while about one in five (22%) say they should let them expire, the latest KFF Health Tracking Poll finds. Majorities of Democrats (91%), independents (80%), and Republicans (63%) say the enhanced tax credits should be extended by Congress, as do more than half (56%) of…

  • KFF Health Tracking Poll: Views of the One Big Beautiful Bill

    Feature

    This poll finds two-thirds of the public view the "One Big Beautiful Bill" legislation unfavorably, and its favorability erodes further when people hear about its potential health impacts. As Congress debates changes to Medicaid and the ACA as part of the bill, each program's popularity is at a record high.

  • Poll: Public Views “Big Beautiful Bill” Unfavorably by Nearly a 2-1 Margin; Democrats, Independents and Non-MAGA Republicans Oppose It, While MAGA Supporters Favor It

    News Release

    Medicaid Work Requirements Are Generally Popular, But Arguments Can Shift Views Nearly two-thirds (64%) of the public holds unfavorable views of the “One Big Beautiful Bill” passed last month by the House, nearly twice the share who view the bill favorably (35%), a new KFF Health Tracking Poll finds. The budget reconciliation bill that includes tax and budget cuts – much of which affect health care – is viewed unfavorably by large majorities of Democrats…

  • How Individual Market Enrollment Changed with the Enhanced Premium Tax Credits

    Feature

    This chart examines individual market enrollment data from 2011 through 2025, when enrollment reached a record high of 25.2 million people. Affordable Care Act (ACA) Marketplace enrollment increased following the enactment of enhanced premium tax credits in 2021, as more individuals became eligible for subsidies.

  • How the Trump Administration and Congress Are Reshaping the Affordable Care Act’s Marketplaces: Views from the States

    Event Date:
    Event

    Through regulations and the House budget reconciliation bill, significant changes are being considered by Congress and the Trump Administration for how the Affordable Care Act’s health insurance Marketplaces would work. To examine how these changes could reshape the ACA’s Marketplaces, KFF held a virtual briefing on June 11 featuring leaders from two state-based Marketplaces to get perspectives from the field.

  • Making the Marketplaces Great Again?

    From Drew Altman

    In his latest column, President and CEO Drew Altman discusses how, with nearly half, or about 10 million MAGA supporters and Republicans receiving coverage through the ACA Marketplaces, the policy changes and cuts being considered by Republicans to the Marketplaces will directly affect their own voters. Altman writes: "Republicans are no longer interested in repealing the ACA but seem comfortable shrinking it significantly if they can, so long as they don’t touch protections for pre-existing…