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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

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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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  • Trends in the Use of Hospital and Provider Quality Ratings

    Poll Finding

    With a renewed emphasis on health care quality driven by the Affordable Care Act, this polling data note examines historical trends in Americans' reliance on quality ratings and how their perceptions have changed over time. Data Note (.pdf)

  • Implementing the ACA’s Medicaid-Related Health Reform Provisions After the Supreme Court’s Decision

    Issue Brief

    On June 28, 2012, the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act (ACA). A majority of the Court also found the ACA’s Medicaid expansion unconstitutionally coercive of states, while a different majority of the Court held that this issue was fully remedied by limiting the Health and Human Services (HHS) Secretary’s enforcement authority. The practical effect of the Court's decision makes the Medicaid expansion optional for states. This brief addresses questions…

  • The Right Care at the Right Time: Are Retail Clinics Meeting a Need?

    Event Date:
    Event

    The Alliance for Health Reform and WellPoint, Inc. discuss the role of urgent care centers and retail clinics emerging within the health care system. Panelists will explore such questions as: Can savings and improved access to care be produced through alternative care settings? Will these settings reduce emergency room use for primary care? Do they have the potential to ease the shortage of primary care providers? Who is monitoring the quality of care being delivered…

  • Chartpack: Kaiser Health Tracking Poll — September 2009

    Poll Finding

    This document contains the chartpack from the September Health Tracking Poll. The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted August 4 through August 11, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (801) and cell phone (402, including 123 who had no landline telephone) were carried out in English and Spanish. The margin of…

  • Toplines: Kaiser Health Tracking Poll — August 2009

    Poll Finding

    This document contains the toplines from the August Health Tracking Poll. The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted August 4 through August 11, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (801) and cell phone (402, including 123 who had no landline telephone) were carried out in English and Spanish. The margin of…

  • Optimizing Medicaid Enrollment: Spotlight on Technology – Using Schools and Data Matching to Enroll Kids in Medicaid and CHIP

    Issue Brief

    This brief examines efforts by the Chicago Public School system to use multiple strategies including data matching with the school lunch program, marketing and local organizing to target children for outreach and enrollment in public health insurance and other benefits. It is the third 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…

  • KFF Analysis Finds Physician Networks in ACA Marketplace Plans Vary Widely, and Enrollees Typically Pay More in Premiums to Access Broader Networks

    News Release

    A KFF analysis of physician networks in the Affordable Care Act’s Marketplace plans finds wide variations in the share of local practicing physicians who participate, with the least costly plans generally having a smaller share of physicians than more expensive plans. The analysis examines the breadth of physician networks listed in Marketplace plan directories in 2021 in nearly every county nationally in relation to the number of actively practicing physicians locally.  On average, Marketplace enrollees…

  • The Biden Administration’s Final Rule on Section 1557 Non-Discrimination Regulations Under the ACA

    Issue Brief

    This brief overviews the Biden Administration’s 2024 final rule implementing Section 1557 of the ACA, which is home to the law’s major nondiscrimination provisions. It provides a brief background on 1557 rulemaking and identifies key differences between this rule and the 2020 rule from the Trump Administration. It highlights two areas of growing interest impacted by the rule – nondiscrimination protections related to pregnancy and nondiscrimination protections for transgender people. Table 2 summarizes the major…