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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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  • Survey of Health Insurance Marketplace Assister Programs

    Report

    This survey by the Kaiser Family Foundation of Navigators and other Marketplace consumer assistance programs under the Affordable Care Act (Obamacare) offers a nationwide analysis of the number and distribution of assisters and people they helped. The report examines the experience of programs in conducting outreach and enrollment assistance during the first open enrollment period. It also reviews the nature of help consumers needed applying for Medicaid or premium tax credits and understanding health insurance…

  • Pre-Existing Condition Prevalence Among Women Under Age 65

    Issue Brief

    We analyzed data from the 2018 National Health Interview Survey (NHIS) and 2018 Behavioral Risk Factor Surveillance System (BRFSS) to calculate prevalence rates of declinable health conditions. This data note looks at the share of adults ages 18-64 with declinable pre-existing conditions, with a particular focus on women.

  • Medicaid’s Role for Hispanic Americans

    Fact Sheet

    This fact sheet examines Medicaid's role for Hispanic Americans. It includes data on Medicaid's coverage of Hispanic Americans and the program's impact on their access to care, as well as the impacts of the recent recession and the coming expansion of Medicaid under health reform on enrollment in Medicaid among Hispanic Americans. The fact sheet also has a chart showing state-by-state data on health insurance coverage of Hispanic Americans. Fact Sheet (.pdf)

  • Massachusetts Special Election Poll

    Poll Finding

    The Foundation, as part of The Washington Post/Kaiser Family Foundation/Harvard University partnership series, conducted a poll to better understand how health care played into the mix of issues and frustrations that brought voters to the polls in the Massachusetts special election for U.S. Senate. The poll was conducted among a random sample of 880 voters in the Massachusetts special election on January 19, 2010 and also interviewed were 242 Massachusetts adults who did not participate…

  • Pulling It Together: Health IN the Economy

    Perspective

    I am writing this Pulling It Together column about this one chart and its potential interpretations and implications. Source: Key Findings: Kaiser Health Tracking Poll: Election 2008 -- April 2008, Kaiser Family Foundation, April 2008. This chart from our most recent tracking poll shows the economy rising as a political issue and health care falling, with Iraq in the middle. Findings from other polling groups will show the same thing for as long as the economy…

  • Poll: Most of the Public Support Extending the ACA’s Enhanced Premium Tax Credits, Including Most Republicans and MAGA Supporters

    News Release

    With the Affordable Care Act’s (ACA) enhanced premium tax credits set to expire at the end of 2025, a large majority (77%) of the public favor Congress extending the credits while about one in five (22%) say they should let them expire, the latest KFF Health Tracking Poll finds. Majorities of Democrats (91%), independents (80%), and Republicans (63%) say the enhanced tax credits should be extended by Congress, as do more than half (56%) of…

  • Pending Changes to Marketplace Plans Could Increase Cost Sharing for Consumers

    Policy Watch

    This brief looks at changes to Marketplace plans recently finalized by the Centers for Medicare and Medicaid Services (CMS) that may incentivize insurers to make their plans less generous. With less generous plans, consumers could face higher out-of-pocket costs, though those who don't qualify for premium tax credits could see lower premiums.

  • Medical Debt Among Insured Consumers: The Role of Cost Sharing, Transparency, and Consumer Assistance

    Perspective

    This policy insight examines medical debt among insured consumers, exploring how high cost sharing in health insurance plans can contribute, and explaining how greater transparency could help consumers avoid some financial pitfalls. It also provides an update on provisions of the Affordable Care Act meant to increase health plan transparency and bolster consumer assistance.

  • High Health-Care Prices: More Talk Than Action

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman explores how price is the major factor that distinguishes the cost of our health care system from those in other developed nations, yet most efforts in the U.S. to address health-care costs don’t focus on price much at all.

  • The Cost of Not Expanding Medicaid

    Report

    As states wrap up legislative sessions and make decisions about whether to implement the Medicaid expansion included in the Affordable Care Act (ACA), this new analysis highlights the implications of these decisions for coverage, state budgets and providers. The decisions by as many as 27 states not to adopt the Medicaid expansion will leave a many more uninsured; these states would also forgo billions in federal funds.