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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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  • 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…

  • Summary of Key Changes to Medicare in 2010 Health Reform Law   

    Issue Brief

    Summary of Key Changes to Medicare in 2010 Health Reform Law . This brief provides a detailed look at the improvements in Medicare benefits, changes to payments for providers and Medicare Advantage plans, various demonstration projects and other Medicare provisions in the law. It includes a timeline of key dates for implementing the Medicare-related provisions in the law.

  • Explaining Health Care Reform: What is Comparative Effectiveness Research?

    Issue Brief

    The brief examines current funding for comparative effectiveness research, the provisions included in the current health reform legislation, and issues related to which treatments that might be studied, whether and how to weigh costs of care, and how such findings will be used and shared with health-care practitioners and the public. It is part of the Foundation's series of Explaining Health Reform briefs on key concepts in health reform. Brief (.pdf)

  • Kaiser Health Tracking Poll: Election 2008 — March 2008

    Poll Finding

    Growing economic worries have led to a sharp rise in the economy as a campaign issue, eclipsing health on voters’ priority list, as well as Iraq. With economic concerns rising, where will health fit in the ongoing presidential campaign?  This March 2008 poll finds that health care plays a role in two ways: as an independent issue, and as part of the voters’ growing concerns about the economy. Health care ranks third as the issue…

  • 50 Ways to Implement Health Reform: State Challenges and Federal Assistance

    Event Date:
    Event

    This briefing looks into the key challenges facing states, including working within state legislative cycles against tight deadlines in the federal law, creating new roles at the state level as state budgets are being squeezed, and others. It looks at both near-term provisions, such as high risk pools, as well as other provisions farther down the road, such as setting up exchanges and instituting changes to Medicaid eligibility. This August 2 briefing was cosponsored by…

  • Implementing New Private Health Insurance Market Rules

    Issue Brief

    With the Jan. 1, 2014 effective date for implementing major changes in the private insurance market under the Affordable Care Act (ACA) approaching, this brief looks at three proposed federal regulations released in late November 2012 that detail how the ACA’s rules will operate in the following areas: private insurance market reforms, essential health benefits and actuarial value, and wellness programs offered or required by employers under group health plans. These regulations deal with aspects…

  • 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…