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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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  • Enhanced Medicaid Match Rates Expire in June 2011

    Fact Sheet

    This fact sheet discusses the role played by the enhanced federal Medicaid matching funds available to states through the American Recovery and Reinvestment Act of 2009 (ARRA), and the implications for state Medicaid programs as that extra assistance expires June 30, 2011. States used the ARRA enhanced Medicaid funding to address Medicaid funding shortfalls during the economic downturn, and to mitigate program cuts and address budget shortfalls. As national unemployment has increased in recent years…

  • Story Ideas: Impact of the Supreme Court Decision on Health Reform

    Event Date:
    Event

    The Alliance for Health Reform and the Robert Wood Johnson Foundation sponsored this reporters-only briefing to help journalists assess the Supreme Court's decision about the Patient Protection and Affordable Care Act. Full version: Video   Speakers for this session: The panel was moderated by Ed Howard of the Alliance. John R. Lumpkin, Senior Vice President and Director, Health Care Group, Robert Wood Johnson Foundation Alan Weil, National Academy for State Health Policy Michael Cannon, Cato Institute…

  • Key Facts about the Uninsured Population

    Issue Brief

    The number and share of people without insurance grew in 2024, increasing for the first time since 2019, according to KFF's analysis of data from the American Community Survey (ACS). This issue brief describes trends in health coverage in 2024, examines the characteristics of the uninsured population , and summarizes the access and financial implications of not having coverage.

  • CMS Requires More Restrictive Definition of Medical Frailty in New Medicaid Work Requirements Rule

    Quick Insights

    On June 1, 2026, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule on Medicaid work requirements that adopts a restrictive definition of medical frailty—differing from states’ early expectations. The more restrictive definition of medical frailty adopted by the Trump Administration will be challenging for states to implement and could lead to more people falling through the cracks and losing coverage.

  • Kaiser November Health Tracking Poll: Individual Elements of the ACA Popular with the Public

    Perspective

    After taking a negative turn in October, the public’s overall views on the Patient Protection and Affordable Care Act (ACA) returned to a more mixed status this month. Still, Americans remain somewhat more likely to have an unfavorable view of the law (44 percent) than a favorable one (37 percent). The Kaiser Family Foundation's November Health Tracking Poll also finds that individual elements of the law are viewed favorably by a majority of the public. The law’s…

  • Health Reform and Communities of Color: Implications for Racial and Ethnic Health Disparities

    Issue Brief

    This issue brief examines the key provisions of the 2010 health reform law that will expand health coverage and are likely to improve access to care for people of color, as well as some of the other provisions that will likely have either a direct or indirect impact on health disparities. Issue Brief (.pdf)) Previous Version: November 2009 (.pdf)

  • Building an Information Technology Foundation for Health Reform: A look at Recent Guidance and Funding Opportunities

    Issue Brief

    The major coverage provisions in the Affordable Care Act (ACA) go into effect in January 2014 with an expansion of Medicaid eligibility to nearly all individuals under 138% of poverty and new subsidies for individuals with incomes between 138% and 400% of poverty to purchase coverage in newly established Health Insurance Exchanges. The ACA envisions a streamlined and simplified application process with seamless transitions between coverage in the Exchange and Medicaid. Using a web portal,…