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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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  • Two Substantive Sides to Debate Over Obamacare’s ‘Cadillac Tax’

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman says the debate about whether to keep or repeal the Cadillac tax is more than a debate between sound policy and good politics, there are strong substantive arguments on both sides. All previous columns by Drew Altman are available online.

  • Will the Iran Debate Defuse Partisan Battles Over Obamacare?

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman discusses whether the debate about the Iran deal may bring a respite for the Affordable Care Act from politics as usual, and how long it might last. All previous columns by Drew Altman are available.

  • Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals in the U.S.

    Issue Brief

    Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care because of an individual’s sexual orientation or gender identity. This issue…

  • New Tracker Monitors Affordable Care Act Preventive Services Coverage

    News Release

    The Affordable Care Act requires private insurance plans to cover recommended preventive services with no out-of-pocket charges for patients. This slate of covered services can change when the U.S. Preventive Services Task Force and other authorized groups add or modify recommendations; the federal government also periodically issues clarifications to guide health plans in their coverage. A new tracker from the Kaiser Family Foundation monitors the preventive services that must be covered for adults without cost sharing,…

  • I hear there is a special enrollment opportunity for people with very low income. How does that work?

    FAQs

    Starting August 25, 2025, the special enrollment opportunity that allowed individuals with incomes at or below 150% of the federal poverty level to sign up for Marketplace coverage year-round --simply due to their low income --was eliminated. Individuals at this income level might still qualify for special enrollment under other special enrollment events, such as when they lose coverage due to job loss or lose Medicaid coverage.

  • Lowering the Age of Medicare Eligibility to 60 Could Reduce the Cost of Health Care and Have a Modest Effect on the Number of People Who Are Uninsured

    News Release

    A new KFF analysis shows that lowering the age of Medicare eligibility to 60 could improve the affordability of coverage for people who are already insured and expand coverage to over a million of the nation’s 30 million uninsured. Such a policy could provide a path to Medicare coverage for up to 11.7 million people with employer-based insurance and 2.4 million with private, non-group coverage who are ages 60 to 64, although it is unclear…

  • Supplemental Security Income for People with Disabilities: Implications for Medicaid

    Issue Brief

    This issue brief describes key characteristics of SSI enrollees, explains the SSI eligibility criteria and eligibility determination process, and considers the implications of changes in the SSI program for Medicaid, including the effects of the COVID-19 pandemic and resulting economic downturn as well as proposals supported by President Biden that Congress might consider.