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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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  • Massachusetts and Washington: Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared

    Fact Sheet

    This fact sheet examines the similarities and differences between the five-year demonstrations in Massachusetts and Washington state to integrate care and align financing for people dually eligible for Medicare and Medicaid. The states finalized memoranda of understanding (MOUs) with the Centers for Medicare and Medicaid Services in fall 2012, and the demonstrations in each state are set to begin in April 2013. Fact Sheet (.pdf)

  • Mobile Technology: Smart Tools to Increase Participation in Health Coverage

    Issue Brief

    As mobile technology advances and cell phone use continues to increase across demographic groups, there is significant potential to tap these technologies to facilitate enrollment in and retention of health coverage, in both the immediate term and as health reform is implemented. A brief produced in conjunction with The Children's Partnership examines how various tools and strategies, including text messages and smart phone apps, can be used to advance coverage goals. The report focuses especially…

  • Medicaid Matters: Understanding Medicaid’s Role in Our Health Care System

    Fact Sheet

    This fact sheet provides key information about the Medicaid program and its role in our health care system and state economies. The nation’s public health insurance program for low-income people is counter-cyclical, expanding during the recent recession to assist millions of individuals and families affected by the loss of jobs and job-based health insurance. While the program has worked as intended, economic conditions have contributed to growing pressure on state budgets and Medicaid funding. This…

  • A Guide to the Supreme Court’s Affordable Care Act Decision

    Issue Brief

    This policy brief describes the Supreme Court's decision on the Affordable Care Act and looks ahead to the implementation of health reform now that questions about the constitutionality of the law have been resolved. Brief (.pdf)

  • Americans’ Health Priorities Diverge From Washington’s Focus on Obamacare

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman finds the public’s healthcare priorities have more to do with drug costs and other real world issues people deal with using the health care system than the ongoing partisan wrangling over the Affordable Care Act (ACA).

  • AHCA Quiz Icon

    American Health Care Act (AHCA) Quiz

    Feature

    On May 4, 2017, the US House of Representatives approved the American Health Care Act (AHCA), legislation to repeal and replace the Affordable Care Act (ACA).  On May 24, the Congressional Budget Office scored the latest version of this bill. Do you think you’re an expert on the AHCA?  Take this quiz to test your knowledge.

  • Findings from the Field: Enrollment and Consumer Assistance in Four States in Year Three of the ACA

    Issue Brief

    Based on case studies and focus groups, this brief reviews experiences with Medicaid and Marketplace enrollment, renewal, and consumer assistance in Colorado, Connecticut, Kentucky, and Washington as of Spring 2016. These states implemented the Medicaid expansion and established a state-based Marketplace (SBM) in 2014. This brief builds on previous reports that examined states’ preparation for implementation prior to the initial ACA open enrollment period and their experiences after completion of the first and second open…

  • Summary of HHS’s Final Rule on Nondiscrimination in Health Programs and Activities

    Issue Brief

    On May 18, 2016, the Department of Health and Human Services (HHS) published a final rule to implement Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination in health coverage and care based on race, color, national origin, age or disability, and, for the first time sex. This Issue Brief provides a technical summary of Section 1557 and the final rule and highlights new protections and provisions included in the law and rule.…