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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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  • 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…

  • JAMA Forum: Those Pesky Lines Around States

    Perspective

    In this post for The JAMA Forum, the Kaiser Family Foundation's Larry Levitt discusses the concept of allowing insurers to sell health plans across state lines and how such a proposal could affect people with pre-existing conditions.

  • JAMA Forum: What Might an ACA Replacement Plan Look Like?

    Perspective

    Larry Levitt's January 2017 post explains the logistics of a "repeal and delay" approach to the Affordable Care Act, and outlines key elements of a proposed replacement plan from Rep. Tom Price, who is President Trump's nominee for Secretary of Health and Human Services. The post is now available at The JAMA Forum.

  • 5 Million More Older Americans Would Become Uninsured under the House GOP Health Bill, and Many with Coverage Would Pay Steep Increases in Premiums 

    News Release

    As a group, older Americans are likely to see some of the biggest changes in their health insurance under the House-passed American Health Care Act (AHCA). The Congressional Budget Office projects that the number of 50- to 64-year-olds who are uninsured would rise to 10 million in 2026, about 5.1 million more than the number who would be uninsured under current law. Many of those who do have coverage would see steep increases in premiums…

  • U.S. Public Opinion on Health Care Reform, 2017

    Feature

    This slideshow supports a Visualizing Health Policy infographic with JAMA, spotlighting public opinion on health reform in the United States as of 2017, including priorities and views of the Affordable Care Act (also known as Obamacare) and its provisions.