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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.

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

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 Inequity Of The Medicaid Coverage Gap and Why It Is Hard To Fix It

    Perspective

    In this column for the JAMA Health Forum, Larry Levitt explores why the Medicaid "coverage gap" still exists in 12 states that have not expanded their Medicaid programs under the Affordable Care Act, why it matters, and why eliminating it could prove challenging.

  • The Public Weighs In On Medicare Drug Negotiations

    Feature

    This data note from the latest KFF Health Tracking Poll explores the public's views on Medicare drug price negotiation, including how arguments on both sides impact support and opposition; confidence in leaders to do the right thing on drug pricing; and experiences with prescription drug costs.

  • Large Majorities Across Parties Favor Allowing the Federal Government to Negotiate Drug Prices, Even After Hearing Common Arguments About It

    News Release

    Most of the Public Lacks Confidence that President Biden, Congressional Democrats or Republicans Will Do the Right Thing on Drug Prices Allowing the federal government to negotiate with drug companies to lower drug prices for Medicare beneficiaries and people enrolled in private plans – a key cost-saving proposal in the Democrats’ massive reconciliation bill – is favored by large majorities across political partisans, even after they hear arguments from both sides, a new KFF Health…

  • How Marketplace Costs and Premiums Will Change if American Rescue Plan Subsidies Expire

    News Release

    In a new Policy Watch, KFF analysts explore the potential impact of the expiration of the American Rescue Plan Act’s enhanced financial help and new eligibility for the Affordable Care Act’s health insurance Marketplace federal subsidies. While the COVID-19 relief legislation passed earlier this year provides greater subsidy assistance through 2022, Democrats in Congress are currently considering making the temporary federal help permanent or extending it as part of their planned budget reconciliation legislation. The…

  • How Marketplace Costs and Premiums will Change if Rescue Plan Subsidies Expire

    Policy Watch

    In this Policy Watch we explore the potential impact of the expiration of the American Rescue Plan Act’s enhanced financial help and new eligibility for the Affordable Care Act’s health insurance Marketplace federal subsidies. While the COVID-19 relief legislation passed earlier this year provides greater subsidy assistance through 2022, Democrats in Congress are currently considering making the temporary federal help permanent or extending it as part of their planned budget reconciliation legislation.

  • Drug Overdose Deaths Rose During the COVID-19 Pandemic, Particularly Among Black and American Indian/Alaska Native People

    News Release

    Drug overdose deaths rose during the early part of the COVID-19 pandemic, with some of the biggest jumps occurring among people of color, a new KFF analysis finds. The analysis breaks out drug overdose deaths by race and ethnicity for the first nine months of 2020, when the pandemic triggered widespread shutdowns and job losses, to the same period in each of the two prior years. Between 2018 and 2020, drug overdose death rates increased…

  • Substance Use Issues Are Worsening Alongside Access to Care

    Policy Watch

    Drug overdose deaths rose during the early part of the COVID-19 pandemic, with some of the biggest jumps occurring among people of color. This analysis breaks out drug overdose deaths by race and ethnicity for the first nine months of 2020, to the same period in each of the two prior years. It also looks at access to care issues and recent and pending legislation aimed at addressing the nation’s substance use and mental health…

  • Lacking Dental Coverage, Many People on Medicare Forgo Dental Care, Especially Beneficiaries of Color

    News Release

    Many people enrolled in Medicare go without dental care, especially beneficiaries of color, according to a new KFF analysis of dental coverage and costs for people with Medicare. Almost half of all Medicare beneficiaries (47%) did not have a dental visit within the past year as of 2018, the analysis finds, with rates higher among those who are Black (68%) or Hispanic (61%) compared to White beneficiaries (42%). Rates were also higher among those who…