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Affordable Care Act

The ACA MarketplaceS

How Has Marketplace Enrollment Changed Across States in 2026?

Following several years of rapid enrollment growth in the ACA Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the enhanced tax credits, generally saw lower drops in enrollment.

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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  • Unraveling the Mysteries of Biden vs. Trump on Health Care

    From Drew Altman

    In his latest column, KFF President and CEO Drew Altman unravels the differences between Trump and Biden on Medicare, abortion, drug costs and other health-related issues that KFF's new side-by-side candidate analysis examines. From the bird’s eye view, these differences amount to a fork in the road in direction on the role of the federal government in health and federal health spending.

  • Costly GLP-1 Drugs are Rarely Covered for Weight Loss by Marketplace Plans

    News Release

    Affordable Care Act (ACA) Marketplace plans rarely cover GLP-1 drugs approved solely for obesity treatment, according to a new KFF analysis of 2024 federal plan data. Wegovy, a drug that is approved for weight loss, is covered by just 1% of Marketplace prescription drug plans, compared to 82% of Marketplace prescription drug plans for Ozempic, which contains the same active ingredient as Wegovy (semaglutide) but is approved only for diabetes. When GLP-1 drugs are covered…

  • Insurer Strategies to Control Costs Associated with Weight Loss Drugs

    Issue Brief

    Affordable Care Act (ACA) Marketplace plans rarely cover GLP-1 drugs approved solely for obesity treatment, according to a an analysis of 2024 federal plan data. Wegovy, a drug that is approved for weight loss, is covered by just 1% of Marketplace prescription drug plans, compared to 82% of Marketplace prescription drug plans for Ozempic, which contains the same active ingredient as Wegovy (semaglutide) but is approved only for diabetes. This analysis examines publicly available formularies…

  • Health Policy 101 Introduction

    Feature

    Health Policy 101 is a comprehensive guide covering fundamental aspects of U.S. health policy and programs, including Medicare, Medicaid, the Affordable Care Act, employer-sponsored insurance, the uninsured population, health care costs and affordability, women's health issues, and health care politics. It includes overviews of private health insurance regulation, racial and ethnic disparities, public health, international comparison of health systems, U.S. global health policy, and the federal role in health policy. The chapters can be downloaded…

  • The Implications of the Public’s Pre-existing Condition Amnesia

    Perspective

    KFF’s Larry Levitt discusses waning awareness of the Affordable Care Act’s provisions protecting people with pre-existing conditions and examines the Republican Study Committee's budget proposal, which proposes to repeal the provisions.

  • Where ACA Marketplace Enrollment is Growing the Fastest, and Why

    Policy Watch

    In 2024, Affordable Care Act (ACA) Marketplace enrollment hit a new record high, reaching over 21 million people. This policy watch discusses the the factors contributing to the increased enrollment in the fastest growing marketplaces.

  • States with the Fastest Recent Growth in ACA Marketplace Coverage Started with High Uninsured Rates

    News Release

    The states with the fastest recent growth in ACA Marketplace signups also had among the highest uninsured rates previously, as enhanced subsidies helped to make coverage more affordable for many consumers, particularly in southern states that did not expand their Medicaid programs to cover low-income adults, a new KFF analysis finds. The enhanced premium subsidies were first provided in the American Rescue Plan Act in 2021 and then extended through 2025 in the Inflation Reduction Act.…

  • KFF Examines New Rule Giving LGBTQ+ People More Protections Against Discrimination in Health Care

    News Release

    A long-awaited new rule recently finalized by the Biden Administration gives LGBTQ+ people more protections against discrimination when seeking health care and coverage from a range of programs and organizations, including Medicaid, Medicare, Health Insurance Marketplaces, many health insurance plans, and most hospitals and providers. The rule has been subject to a wave of litigation across the Obama, Trump, and Biden Administrations and the Biden Administration's new rule reinstates protections eliminated by the Trump Administration.…

  • 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…