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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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  • The Health Reform Law’s Medicaid Expansion: A Guide to the Supreme Court Arguments

    Issue Brief

    One significant element of the pending U.S. Supreme Court case challenging the Affordable Care Act is the constitutionality of the law's Medicaid expansion. This provision of the law requires states that choose to participate in the Medicaid program to cover nearly all adults under age 65 with household incomes at or below 133% of the federal poverty level as of January 2014. A ruling on the Medicaid expansion could have far-reaching impacts on the present…

  • How Medicaid Section 1115 Waivers Are Evolving: Early Insights About What to Watch

    Issue Brief

    While efforts to pass major federal legislation to repeal and replace the Affordable Care Act (ACA) and restructure and reduce federal Medicaid financing may be on hold temporarily, the focus of the Centers for Medicare and Medicaid Services (CMS) and states is expected to turn to achieving significant Medicaid program changes through Section 1115 demonstration waivers. This issue brief presents three questions to help analyze the evolution of federal waiver policy as new waiver proposals…

  • Analysis: Most Short-Term Health Plans Don’t Cover Drug Treatment or Prescription Drugs, and None Cover Maternity Care

    News Release

    A new Kaiser Family Foundation analysis of short-term, limited duration health plans for sale through two major national online brokers finds big gaps in the benefits they offer. Through an executive order and proposed new regulations, the Trump Administration is seeking to encourage broader use of short-term, limited duration health plans as a cheaper alternative to individual market plans that comply with the Affordable Care Act’s requirements. Repeal of the individual mandate penalty – which…

  • Optimizing Medicaid Enrollment: Perspectives on Strengthening Medicaid’s Reach Under Health Care Reform

    Issue Brief

    The health reform law creates a national plan for near-universal health coverage that relies on a large expansion of Medicaid eligibility as its foundation. This brief draws on recent interviews with Medicaid program directors and other experts about the opportunities that health reform presents to optimize Medicaid by strengthening its enrollment and renewal operations and recasting it as an affordable health coverage program for working people and families. Executive Summary (.pdf) Issue Brief (.pdf)

  • Liking the Pieces, Not the Package: Contradictions in Public Opinion During Health Reform

    Poll Finding

    Public opinion played a prominent role during the recent health care reform debate. In a published Health Affairs article, Kaiser researchers examine past and present polling and show that opinion tracked with historic patterns and was relatively stable, even if the contentious public debate suggested a volatile public mood in 2009 and 2010. Going forward, the public will begin reacting to reform implementation, primarily by judging it in terms of their perceptions of and experiences…

  • Pulling It Together: Rising Health Costs Are Not Just a Federal Budget Problem

    Perspective

    Premiums for employer-provided health insurance, where 150 million Americans get their coverage, jumped 9% in 2011 while workers’ wages grew just 2%, according to our annual employer survey.  The average family policy now costs more than $15,000 per year, more than the cost of a Chevy Aveo or a Ford Fiesta.  Since we began doing this survey thirteen years ago, worker contributions to premiums have increased 168%, wages 50%, and inflation 38%. Critics of the…

  • Small Area Variations and the ACA’s Coverage Expansions

    From Drew Altman

    A new Kaiser analysis sheds light on how the country might react to the Affordable Care Act (ACA) when it is implemented.  It looks at how the benefits of the ACA's coverage expansions will vary around the country by census areas (technically, Public Use Microdata Areas, or PUMAs).  PUMAs are artificial areas of about 100,000 people each created by the Census Bureau to provide more detailed demographic, social and economic information at the local level.  They…