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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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  • With Federal Support, States Hold Steady in Medicaid and CHIP Coverage Policies for Low-Income Children and Families Despite Recession

    News Release

    New 50-State Survey Finds Some States Make Targeted Expansions to Strengthen Coverage and Achieve Efficiencies as They Prepare for Health Reform WASHINGTON -- Despite tight budgets, nearly all states maintained or made targeted expansions or improvements in their Medicaid and Children’s Health Insurance Programs (CHIP) eligibility and enrollment rules in 2010, preserving the programs’ ability to provide coverage to millions of low-income Americans who otherwise lack affordable options, according to a new survey released today…

  • How Will Health Reform Impact Young Adults?

    Issue Brief

    Adults ages 19 to 29 have the highest uninsured rate of any age group in the United States. The 13.7 million uninsured people in this age group comprise nearly a third of the overall uninsured population.  Most provisions in health reform do not specifically target young adults, but because of their high uninsured rate they will be one of the groups that is most affected by the new law. This paper explains the key ways in…

  • Voters Aren’t Buying Trump’s Promises of a Health Care Plan

    From Drew Altman

    Drew Altman showcases new KFF polling on the public’s views of President Trump’s promise that he will have a “phenomenal” health care plan and protect Medicare, and analyzes what it means for health care politics.

  • How Affordability of Employer Coverage Varies by Family Income

    Issue Brief

    This analysis looks at the share of family income people with employer-based coverage pay toward their premiums and out-of-pocket payments for medical care. The cost of employer sponsored health insurance—including premiums, deductibles, and other out-of-pocket costs—has risen steadily over time.

  • 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 — August 2009

    Poll Finding

    The August Kaiser Health Tracking Poll finds a slim majority of Americans continues to favor moving forward on health care reform now despite an intensifying ad war and a political climate of contentious town hall meetings that coincide with rising concerns about the reform effort. Fifty-three percent of the public believes that tackling health reform is more important than ever, compared to 42 percent who say we cannot afford to take on health care reform…

  • Immigrants’ Health Coverage and Health Reform: Key Questions and Answers

    Issue Brief

    As health reform discussions continue, there has been some focus on health coverage for immigrants and how immigrants will be treated under reform plans being considered on Capitol Hill. This issue brief provides an overview of key questions related to immigrants' health coverage and health reform, addressing subjects such as how immigrants receive health coverage, how many of the uninsured are non-citizen immigrants and what would happen to coverage for non-citizen immigrants under current health…