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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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  • Health Insurance Market Reforms: Rate Restrictions

    Fact Sheet

    Rate restrictions limit how much insurance companies can vary premiums charged to individuals and businesses based on factors such as health status, age, tobacco use and gender. Currently, federal law does not place any limits on the ways that insurance companies set their premium rates. However, beginning January 1, 2014, insurance companies must meet the Affordable Care Act's minimum premium rating rules for health plans for individuals and small businesses. This brief explains the current…

  • Health Care After the Supreme Court Decision: What’s Next?

    Event Date:
    Event

    The Alliance for Health Reform and the Kaiser Family Foundation discuss the recent Supreme Court ruling on the constitutionality of the health reform law. Panelists explore such questions as: What does the court's ruling mean for those without health insurance? Will states that choose to participate in the Medicaid expansion be ready to cover nearly all non-disabled adults under age 65 with household incomes at or below 133 percent of the federal poverty level as…

  • Financial Incentives in the Long-Term Care Context: A First Look at Relevant Information

    Report

    Financial Incentives in the Long-Term Care Context: A First Look at Relevant Information This report reviews Medicare's payment policies as they may affect medical care for residents in long-term care environments, including a look at the financial incentives that could play a role in hospital and skilled nursing facility admissions. The report was prepared by Henry Desmarais at Health Policy Alternatives for the Foundation and released at an Oct. 12, 2010, policy briefing. Report (.pdf)

  • The New Review and Approval Process Rule for Section 1115 Medicaid and CHIP Demonstration Waivers

    Fact Sheet

    For many years, Section 1115 waivers have been used in the Medicaid program to provide states an avenue to test and implement coverage approaches that do not meet federal program rules, but there have been longstanding concerns about the lack of public input and transparency in the waiver approval process. As a result, the Affordable Care Act required the Department of Health and Human Services to issue regulations designed to ensure that the public has…

  • 2008 Update on Consumers’ Views of Patient Safety and Quality Information

    Poll Finding

    2008 Update on Consumers' Views of Patient Safety and Quality Information An updated examination of consumers' views on health care quality information reveals major challenges remain in providing the public with comparative quality information and encouraging its use. The 2008 Update on Consumers' Views of Patient Safety and Quality Information finds that three in 10 (30%) Americans say they have seen health care quality comparisons of health insurance plans, hospitals, or doctors in the past…

  • Explaining Health Care Reform: What Is An Employer “Pay-or-Play” Requirement?

    Issue Brief

    To broaden coverage, some health reform proposals would require employers to offer coverage or pay to help finance subsidies for those without access to affordable coverage. These types of reforms are often referred to as “pay-or-play” policies. The brief explains the concept and policy implications of employer pay-or-play proposals, which can vary in terms of the level of coverage required for compliance, the cost of the penalty to employers who do not offer, and whether…

  • Key Findings: Kaiser Health Tracking Poll — November 2009

    Poll Finding

    This document contains the key findings from the November Health Tracking Poll. The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted November 5 through November 12, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (802) and cell phone (401, including 112 who had no landline telephone) were carried out in English and Spanish. The margin…

  • Survey of People Who Purchase Their Own Insurance

    Poll Finding

    While most people in the U.S. get health insurance through their employer, about 14 million people under age 65 have coverage through the non-group or individual market, which has faced scrutiny recently in news reports about some insurers’ steep rate increases and in the market reforms in the new health reform law that will take effect in 2014. This survey provides insight into the current state of the non-group market and finds policyholders report that…

  • The Digital Divide And Access To Health Information Online

    Poll Finding

    The Affordable Care Act (ACA) calls for a number of web-based initiatives, including development of the website healthcare.gov which provides a variety of health information and helps individuals find coverage options. Therefore, understanding the level and quality of Internet access among those groups most likely to benefit from reform, such as the uninsured, those with lower incomes, and members of racial and ethnic minority groups, is an important consideration as health reform is implemented. A…

  • Primers on Key Health Care Topics and Programs

    Issue Brief

    The Kaiser Family Foundation maintains a number of primers providing overviews of key health care programs and issues. Written by Foundation staff, each primer provides key data and information that helps illustrate the topic and its relevance for the nation's health care system. Medicaid: A Primer Medicare: A Primer The Uninsured: A Primer Health Care Costs: A Primer How Private Health Coverage Works: A Primer Mental Health Financing in the United States: A Primer The…