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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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  • Eliminating the ACA Medicaid Expansion Match Could Reduce Total Medicaid Spending by Up To $1.9 Trillion Over 10 Years and End Coverage for 20 Million People 

    News Release

    A new KFF analysis finds that a congressional proposal to significantly cut federal spending on the Affordable Care Act’s Medicaid expansion could reduce total Medicaid spending by up to nearly one-fifth, or $1.9 trillion, over a 10-year period, and end Medicaid coverage for as many as 20 million people.The impacts would be felt in both blue and red states and could effectively reverse and end the Medicaid expansion in most or all states that have…

  • A quote in green text against a white background reads, "The math is conclusive: Major cuts to Medicaid are the only way to meet the House’s budget resolution requirements. There are a myriad of options available for cutting Medicaid, but all of them would leave the states facing  difficult choices to raise revenues or cut spending."

    The Math is Conclusive: Major Medicaid Cuts Are the Only Way to Meet House Budget Resolution Requirements

    Quick Insights

    The CBO letter confirms early expectations, finding that over the next 10 years, 93% of non-Medicare spending in the E&C [House Energy & Commerce Committee] jurisdiction is from the federal share of Medicaid spending…Even if E&C eliminated all non-Medicaid and CHIP spending, the committee would need to cut federal spending on Medicaid and CHIP by well over $700 billion, nearly 10% of projected spending.

  • What Would Another Trump Presidency Mean for Health Care?

    Perspective

    In a new column in JAMA Health Forum, Larry Levitt, KFF’s executive vice president for health policy, explores what a second Trump presidency might mean for health policy based on his record and remarks, including potentially weakening the Affordable Care Act, reducing federal Medicaid costs, and restricting access to abortion.

  • Where ACA Marketplace Enrollment is Growing the Fastest, and Why

    Policy Watch

    In 2024, Affordable Care Act (ACA) Marketplace enrollment hit a new record high, reaching over 21 million people. This policy watch discusses the the factors contributing to the increased enrollment in the fastest growing marketplaces.

  • With or Without ACA Repeal, ACA and Medicaid Cuts are Looming

    Perspective

    In this JAMA Health Forum post, Executive Vice President Larry Levitt explores why the incoming Trump administration and Republican majorities in Congress are likely to pursue budget cuts in Medicaid and the Affordable Care Act and why such efforts are likely to boost the number of uninsured Americans.

  • Signing Up for Marketplace Coverage Remains a Challenge for Many Consumers

    Policy Watch

    As open enrollment begins for Marketplace plans, this Policy Watch provides information about consumer experiences with Marketplace sign up from the 2023 KFF Consumer Survey. Data from the survey show that Marketplace sign up has been a challenge to many consumers---often more complicated than enrollment in other kinds of health insurance. The Policy Watch also spotlights efforts to address common enrollment problems such as option overload and transitioning to Marketplace coverage from other forms of…

  • Medicare-for-All and Public Plan Buy-In Proposals: Overview and Key Issues

    Issue Brief

    This issue brief compares eight Medicare-for-All and public plan option bills that have been introduced in the 115th Congress. The brief describes the range of proposals on the table and raises key questions related to how these proposals could affect coverage, out-of-pocket costs, existing coverage, payments to providers, as well as overall costs and financing, and potential tradeoffs.