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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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  • Teens, Drugs, and Overdose: Contrasting Pre-Pandemic and Current Trends

    Issue Brief

    This brief analyzes the latest CDC data on adolescent overdose deaths, finding that from 2022 to 2023, there was a small reduction in overdose fatalities among adolescents (from 721 to 708 deaths). Additionally, the synthetic opioid, fentanyl, has largely driven the increase in adolescent drug fatalities since the pandemic began, accounting for 76% of these fatalities in 2023. This analysis also explores federal and state policy responses to the drug crisis, such as requirements to…

  • KFF Health Tracking Poll: Public Weighs Health Care Spending and Other Priorities for Incoming Administration

    Feature

    With the incoming Trump administration and Republican-led Congress looking to ways to reduce federal spending, this Poll finds that the Medicare and Medicaid programs remain broadly popular, and more people favor more spending on those programs than less spending. Among potential actions on health, the public sees price transparency and limiting chemicals in food as top priorities. Few say so about cuts to Medicaid and restrictions on abortion.

  • Claims Denials and Appeals in ACA Marketplace Plans in 2023

    Issue Brief

    This brief analyzes federal transparency data released by the Centers for Medicare and Medicaid Services (CMS) on claims denials and appeals for non-group qualified health plans (QHPs) offered on HealthCare.gov in 2023. It finds that HealthCare.gov insurers denied nearly one out of every five claims (19%) submitted for in-network services. Information about the reasons for denials is limited, and few consumers appeal claims denials.

  • HealthCare.gov Insurers Denied Nearly 1 in 5 In-Network Claims in 2023, but Information About Reasons is Limited in Public Data

    News Release

    HealthCare.gov insurers denied nearly one out of every five claims (19%) submitted for in-network services and an even larger share (37%) share of claims for out-of-network services in 2023, a new KFF analysis finds. The analysis examines the main source of publicly available data on claims denials and appeals for individual-market plans available through the federal HealthCare.gov marketplace. The Affordable Care Act requires certain entities to report data about claims denials and appeals to encourage…

  • Congressional District Interactive Map: How Much Will ACA Premium Payments Rise if Enhanced Subsidies Expire?

    Issue Brief

    This analysis and interactive map illustrate how much more enrollees in Affordable Care Act (ACA) Marketplace plans would pay in premiums at the congressional district level if the enhanced subsidies were to expire in 2026 as under current law. The tool presents scenarios for an older couple who would lose subsidy eligibility due to their income level and for a single person with a $31,000 income. It also presents net average premium payment increases in…

  • A Medicaid Per Capita Cap: State by State Estimates

    Issue Brief

    This analysis examines the potential impacts on states, Medicaid enrollees, and providers of implementing a per capita cap on federal Medicaid spending, which is one proposal that has been discussed in Congress. Such a plan could decrease federal Medicaid spending by $532 billion to almost $1 trillion over a 10-year period, depending on how states respond. An estimated 15 million people could lose Medicaid coverage by 2034.

  • Who Might Lose Eligibility for Affordable Care Act Marketplace Subsidies if Enhanced Tax Credits Are Not Extended?

    Policy Watch

    This analysis looks at the individual market enrollees who make at least four times the federal poverty level who would no longer be eligible for any tax credits if the current ACA Marketplace enhanced subsidies expire at the end of this year. Compared to other people with similar incomes, these enrollees are more likely to be early retirees, self-employed and living in rural areas.

  • The Role of the Basic Health Program in the Coverage Continuum: Opportunities, Risks & Considerations for States

    Issue Brief

    This brief assesses the potential benefits and drawbacks to states from implementing a Basic Health Program under the Affordable Care Act. The law gives states the option of creating a Basic Health Program, using federal tax money to subsidize insurance coverage for low-income residents who would otherwise be eligible to purchase coverage through a state exchange. Such a program would give states the ability to provide more affordable coverage for these low-income residents and improve…

  • 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…