Affordable Care Act

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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  • 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…

  • New Analysis Summarizes Recent Research on the Effects of ACA Medicaid Expansion, Providing Context for Renewed Expansion Debates in States

    News Release

    New federal financial incentives for Medicaid expansion and the increased reliance on Medicaid as a coverage safety net during the pandemic have renewed debate in the 12 states that have not adopted the Medicaid expansion under the Affordable Care Act. A new KFF literature review provides context for these expansion debates by summarizing evidence from nearly 200 studies about the effects of Medicaid expansion that were published between February 2020 and March 2021. These studies…

  • Vast Majority of Large Employers Surveyed Say Broader Government Role Will Be Necessary to Control Health Costs and Provide Coverage, Survey Finds

    News Release

    Top executives at nearly 90% of large employers surveyed believe the cost of providing health benefits to employees will become unsustainable in the next five-to-10 years, and 85% expect the government will be required to intervene to provide coverage and contain costs, according to a new survey released today from Purchaser Business Group on Health (PBGH) and KFF (Kaiser Family Foundation), with support from the West Health Institute. The research exposes large employers’ mounting concerns…

  • Corporate Leaders Are Getting Bullish On Government Action On Health Care Costs

    From Drew Altman

    In this Axios column, Drew Altman explores whether the long struggle with rising health costs has caused the tide to turn in corporate leaders’ attitudes towards government involvement in controlling health spending and whether it is part of a larger shift in comfort with government action to solve problems.

  • 2021 Calculadora del Mercado de Seguros Médicos

    Interactive

    Nota: Esta calculadora ha sido actualizada con los cambios a los subsidios en el American Rescue Plan Act de 2021 (el acta de alivio por COVID-19). Esta calculadora ilustra las primas (el costo mensual de su seguro) y subsidios para las personas que compran seguro médico por su propia cuenta en el nuevo mercado de seguros de salud (o de intercambio) creado por la Ley de Cuidado de Salud a Bajo Precio (Affordable Care Act,…

  • 2021 Health Insurance Marketplace Calculator

    Interactive

    The Health Insurance Marketplace Calculator, updated with 2021 premium data and to reflect subsidies in the American Rescue Plan Act of 2021, provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA). With this calculator, you can enter your income, age, and family size to estimate your eligibility for subsidies and how much you could spend on…