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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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  • Three Quarters of the Public, Including a Majority of Trump Supporters, Want President Trump to Try to Make the Affordable Care Act Work

    News Release

    Americans See Many Factors Behind AHCA’s Failure, But Few Republicans Blame President Trump Despite divided views about the Affordable Care Act, three-fourths of the public (75%) say President Trump and his administration should do what they can to make the law work, while one in five (19%), including 38 percent of Republicans, say the Administration should do what it can to make the law fail so they can replace it later, the latest Kaiser Health…

  • A Warning From the Polls About Letting Obamacare “Explode”

    From Drew Altman

    In this column for Axios, Drew Altman sees a warning for the Trump administration and Republicans in the latest Kaiser Tracking Poll: the more they do to undermine the Affordable Care Act marketplaces the more the public is likely to hold them, and not the Democrats, accountable for the problems with the law.

  • JAMA Forum: Is the Affordable Care Act Imploding?

    Perspective

    In this April 2017 post, Larry Levitt discusses the current status of the Affordable Care Act's health insurance marketplaces, and explains how the Trump administration's choices -- including whether to continue cost-sharing reduction payments to insurers -- could influence stability of the marketplaces going forward. The post is now available at The JAMA Forum.

  • Data Note: Medicaid Managed Care Growth and Implications of the Medicaid Expansion

    Issue Brief

    Most states today rely heavily on risk-based managed care organizations (MCOs) to serve Medicaid beneficiaries. This Data Note discusses the current role of managed care in Medicaid and examines differences in managed care growth between states that expanded Medicaid to low-income adults under the Affordable Care Act (ACA) and states that did not expand Medicaid.

  • The Other Implication of the CBO Report: Election-Year Pain

    From Drew Altman

    In this Axios column, Drew Altman lays out how the “political pain” from the American Health Care Act would play out over the next two election cycles if passed in its current form, based on the Congressional Budget Office’s analysis of the House-passed bill.

  • Analysis: Strong Favorable Views of ACA Increased in Spring 2017, Strong Unfavorable Views Remain Flat

    News Release

    Since the passage of the Affordable Care Act in 2010, Kaiser Family Foundation polling has found the public divided in their overall views of the law and in the intensity of their opinions: For seven years, the share of the public holding strongly unfavorable views of the law has outnumbered the share with strongly favorable views. A new analysis of Kaiser Family Foundation polling data finds that intensity gap started to close in spring 2017, as…

  • August Kaiser Health Tracking Poll: The Uninsured and the Health Reform Law

    Perspective

    The August Kaiser Health Tracking Poll finds that even though 32 million uninsured Americans will gain health insurance under the ACA, only about half of non-elderly Americans currently without coverage say they are familiar with the chief components in the law designed to achieve this goal. Fifty-two percent of the uninsured say they are aware the law will provide subsidies to help low- and moderate-income people without insurance purchase it. And 47 percent are aware that…

  • More Support Than Oppose Their State Expanding Medicaid

    Feature

    More Support Than Oppose Their State Expanding Medicaid Download Source Kaiser Family Foundation/Robert Wood Johnson Foundation/Harvard School of Public Health, The Public’s Health Care Agenda for the 113th Congress (conducted January 3-9, 2013)

  • States’ Participation in Six Key Medicaid Long-Term Services and Supports Options Provided or Enhanced by the Affordable Care Act

    Feature

    States’ Participation in Six Key Medicaid Long-Term Services and Supports Options Provided or Enhanced by the Affordable Care Act Download Source M. O’Malley Watts, M. Musumeci, and E. Reaves, How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports (LTSS) Today? State Adoption of Six LTSS Options, The Henry J. Kaiser Family Foundation, April 2013, available at: http://www.kff.org/medicaid/issue-brief/how-is-the-affordable-care-act-leading-to-changes-in-medicaid-long-term-services-and-supports-ltss-today-state-adoption-of-six-ltss-options/;  updates available at: http://www.kff.org/state-category/health-reform/.