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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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  • The Implications of COVID-19 for Mental Health and Substance Use

    Issue Brief

    This brief explores mental health and substance use during, and prior to, the COVID-19 pandemic. We highlight populations that were more likely to experience worse mental health and substance use outcomes during the pandemic and discuss some innovations in the delivery of services.

  • 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

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    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.

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    Fact Sheet

    La crisis de $73 mil millones de Puerto Rico ha sido tema de los medios de comunicación nacionales, y de debate en el Congreso en los últimos meses. Además, varios de los principales medios de prensa han reportado sobre una inminente crisis de la atención de salud relacionada con cuestiones demográficas y del financiamiento del cuidado de salud, y exacerbada por la actual situación económica y el aumento de casos de trasmisión del virus del…

  • Examining Prior Authorization in Health Insurance

    Policy Watch

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  • The Implications of the Most Recent Challenge to the ACA’s Preventive Care Requirement Could Affect Millions

    News Release

    A new brief explains the implications of the most recent legal challenge contesting the Affordable Care Act’s (ACA) requirement that most private insurance plans cover specific preventive care items and services—such as contraceptive services and supplies, and cancer screenings—at no cost to patients. In Braidwood Management v. Becerra, two Christian-owned businesses and six individuals in Texas have challenged the legality of the preventive care mandates on constitutional grounds. The plaintiffs are also challenging the requirement…