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Affordable Care Act

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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  • Physician Workforce: The Next Generation

    Event Date:
    Event

    The new health reform law poses questions about how the increase in the insured population will affect the demand on the health care workforce. Will it increase the shortage among primary care physicians? What about specialists? How much of the workforce shortage can be alleviated by payment incentives in the new law for both primary care and general surgery, and other new incentives to practice in underserved areas? Are there enough effective efforts in place…

  • Kaiser Health Tracking Poll: Election 2008 — March 2008

    Poll Finding

    Growing economic worries have led to a sharp rise in the economy as a campaign issue, eclipsing health on voters’ priority list, as well as Iraq. With economic concerns rising, where will health fit in the ongoing presidential campaign?  This March 2008 poll finds that health care plays a role in two ways: as an independent issue, and as part of the voters’ growing concerns about the economy. Health care ranks third as the issue…

  • 50 Ways to Implement Health Reform: State Challenges and Federal Assistance

    Event Date:
    Event

    This briefing looks into the key challenges facing states, including working within state legislative cycles against tight deadlines in the federal law, creating new roles at the state level as state budgets are being squeezed, and others. It looks at both near-term provisions, such as high risk pools, as well as other provisions farther down the road, such as setting up exchanges and instituting changes to Medicaid eligibility. This August 2 briefing was cosponsored by…

  • Implementing New Private Health Insurance Market Rules

    Issue Brief

    With the Jan. 1, 2014 effective date for implementing major changes in the private insurance market under the Affordable Care Act (ACA) approaching, this brief looks at three proposed federal regulations released in late November 2012 that detail how the ACA’s rules will operate in the following areas: private insurance market reforms, essential health benefits and actuarial value, and wellness programs offered or required by employers under group health plans. These regulations deal with aspects…

  • Pulling it Together: Duals: The National Health Reform Experiment We Should Be talking More About

    From Drew Altman

    The Center for Medicare & Medicaid Services (CMS) and 26 states are moving to launch a large scale managed care demonstration project potentially involving millions of the poorest, sickest, most expensive Medicare and Medicaid beneficiaries, the so-called dual eligibles. The experiment is getting more and more attention from policy experts, but with controversial issues like the survival of the Affordable Care Act and converting Medicare to a premium support program grabbing the limelight, it has…

  • Covering the Uninsured: Options for Reform

    Issue Brief

    Download PDF Key Facts on the Uninsured In 2007, 45 million nonelderly people in the United States lacked health coverage More than eight in ten uninsured people (81%) come from working families About two-thirds of the nonelderly uninsured are from low-income families (income below 200% of poverty, about $42,400 for a family of 4 in 2007) More than one in three people (35%) living in poverty are uninsured, compared with one in twenty people (5%)…

  • Optimizing Medicaid Enrollment: Spotlight on Technology – Oklahoma’s Automatic Newborn Enrollment System

    Issue Brief

    This brief examines Oklahoma's web-based system for automatically enrolling in its Medicaid program, SoonerCare, and provides an overview of the state's more recent implementation of an online SoonerCare application for children and families, pregnant women, and other adults. It is the fourth 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 their systems…

  • State-Based Efforts Will Provide Limited Relief from Enhanced Tax Credit Expiration

    State-Based Efforts Will Provide Limited Relief from Enhanced Tax Credit Expiration

    Policy Watch

    After failed Senate votes late last year and no subsequent bipartisan agreement, the enhanced premium tax credits expired as of January 1. Some states, particularly those operating State-Based Marketplaces (SBMs), have been preparing for this possibility for months and are moving to blunt the impact on consumers by implementing their own state-funded subsidies and implementing other programs aimed at stabilizing the cost of unsubsidized premiums.

  • KFF Health Tracking Poll: Health Care Costs, Expiring ACA Tax Credits, and the 2026 Midterms

    Poll Finding

    Looking ahead to the midterm elections, health care costs are the public’s top economic concern, and many voters say the issue will have a major impact on their vote. On health care issues, including the cost of health care, voters currently trust Democrats more than Republicans, though neither party has an advantage on addressing the overall cost of living. Following the expiration of the ACA enhanced tax credits, two-thirds of the public say Congress did…