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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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  • 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.…

  • The State of Children’s Health, Care and Coverage

    Event Date:
    Event

    A record 90 percent of children now have health coverage – more than a third of whom are covered by Medicaid and CHIP. Yet about 7.5 million children remain uninsured, including 5 million who are eligible for Medicaid and CHIP but not enrolled. Who are the at-risk kids? How are states faring with enrollment and retention? How will children and families be affected once major parts of the Patient Protection and Affordable Care Act (ACA)…

  • New Orleans Residents Say Recovery Is Making Progress, But Many Believe The Gulf Oil Spill Will Be More Damaging Than Katrina

    News Release

    Crime is By Far The Biggest Concern in New Orleans Seven in 10 Residents Say Americans Have Forgotten The City’s Plight African-Americans View Their Recovery Differently; It’s Much Slower MENLO PARK, Calif. -- Five years after Hurricane Katrina, an increasing majority of the city’s residents says the rebuilding process is going well, but substantial majorities still report that the city has not recovered and feel the nation has forgotten them, according to a new comprehensive…

  • Grandfathering Explained

    Perspective

    The Republican leadership in the House of Representatives recently indicated that it will be seeking to repeal regulations under the Affordable Care Act (ACA) that govern the “grandfathered” status of health plans. As this aspect of the health reform law gets more scrutiny, it may be useful to review some of the specifics of how grandfathering works. The purpose of grandfathering: As provisions of the ACA go into effect, grandfathering provides for a smoother transition by…

  • Pop Quiz: Assessing Americans’ Familiarity with the Health Care Law

    Perspective

    Based on the December Kaiser Health Tracking Poll, the latest KFF data note explores Americans’ awareness of what the Affordable Care Act (ACA) will do. As the 112th Congress prepared to take office and the discussion of repeal was on the rise, we 'quizzed' Americans on whether they thought a series of ten provisions were included in the new law, ranging from five items that are part of the law (i.e., Medicaid expansion, changes in…

  • Health Insurance Coverage for People with HIV Under the Affordable Care Act: Experiences in Five States

    Issue Brief

    To provide greater insight into how Affordable Care Act (ACA) implementation has affected people with HIV during the first year of major insurance expansions, this issue brief examines the experiences of people with HIV based on focus groups conducted in five states: California, Florida, Georgia, New York, and Texas. It is a part of KFF's larger ACA sentinel sites project.