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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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  • SCOTUS Case Could Weaken the Impact of Regulation on Key Patient and Consumer Protections

    Issue Brief

    This brief discusses the longstanding legal doctrine, Chevron deference, being challenged in two cases before the U.S. Supreme Court and includes examples of what could be at stake for health care consumers should federal courts no longer use this doctrine to address litigation related to federal health regulations. The focus here is on patient and consumer protection regulation, but overturning the Chevron deference would have implications in all areas of health care.

  • More On Health and Politics: The Peculiar Timing of Republican Health Policy Plans

    From Drew Altman

    In this column, KFF President and CEO Drew Altman examines the conservative Republican Study Committee’s sweeping proposals to remake Medicare, Medicaid and the Affordable Care Act and their potential to make waves in this year’s elections. Whether former President Trump ignores, embraces, or repudiates their ideas will be key.

  • The Symbolic Manipulation of Health Issues in Elections

    From Drew Altman

    KFF President and CEO Drew Altman explains why data and facts, policy plans and lists of accomplishments do not connect with many voters. Understanding the symbolic dimensions of politics and issues is critical for experts. We can reach a share of the public with facts and data but need additional strategies to reach everyone, including storytelling and trusted messengers.

  • Access to Adult Dental Care Gets Renewed Focus in ACA Marketplace Proposal

    Policy Watch

    Adult dental care can lead to high out of pocket costs for consumers, especially for those with private insurance coverage. This post analyzes a proposed provision in the HHS Notice of Benefit and Payment Parameters for 2025, and possible implications for consumers who have Marketplace coverage.

  • Employer Responsibility Under the Affordable Care Act

    Other Post

    The Affordable Care Act does not require businesses to provide health benefits to their workers, but applicable large employers may face penalties if they don’t make affordable coverage available. The employer shared responsibility provision of the Affordable Care Act penalizes employers who either do not offer coverage or do not offer coverage that meets minimum value and affordability standards. These penalties apply to firms with 50 or more full-time equivalent employees. This flowchart illustrates how…

  • Preventive Services Covered by Private Health Plans under the Affordable Care Act

    Fact Sheet

    Note:  This content was updated on February 28, 2024  to incorporate new FAQs from CMS. Tables 1 and 2 were also updated to include updated recommendations. It has been more than ten years since the Affordable Care Act (ACA) required private insurance plans to cover recommended preventive services without any patient cost-sharing. Research has shown that evidence-based preventive services can save lives and improve health by identifying illnesses earlier, managing them more effectively, and treating…

  • It’s Not a Health Care Election, But Health Issues Might Still Add Up

    From Drew Altman

    In this column, KFF President and CEO Drew Altman explores the potential for some health care issues—including abortion, drug costs and other affordability challenges—to influence enough voters in swing states to make a difference in this year's presidential election.