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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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  • Health Reform Implementation: When Sausage-Making Moves Downtown

    Event Date:
    Event

    Panelists at this briefing examine what's happening behind the scenes to implement the Patient Protection and Affordable Care Act. An overview of federal policymaking and the efforts by stakeholders and others to affect final policies pertaining to the health reform law is provided. The session will look into key tools and levers available to the federal government, including formal rulemaking and other policy processes, as well as efforts by stakeholders and others to affect final…

  • Explaining the State Integrated Care and Financial Alignment Demonstrations for Dual Eligible Beneficiaries

    Issue Brief

    This paper provides an overview of the joint efforts of states and the Centers for Medicare and Medicaid Services (CMS) to develop more integrated ways of paying for and delivering health care to the 9 million people who are eligible for both the Medicare and Medicaid programs. Dual eligible beneficiaries comprise many of the poorest and sickest people covered by either program, and they account for a disproportionately large share of Medicare and Medicaid spending.…

  • Rural Health: Laying the Foundation for Health Reform

    Event Date:
    Event

    The Alliance for Health Reform and the Robert Wood Johnson Foundation co-sponsored this briefing to have a panel of experts answer questions about how some aspects of pending health reform proposals may have a substantial impact on rural care. What provisions in the various reform proposals affect rural health care? What particular challenges need to be overcome in order to improve care delivery in rural areas? What aspects of health reform will require special accommodation…

  • 2008 Election Briefs

    Poll Finding

    Health care remains among the top three election issues voters want to hear the presidential candidates discuss. Kaiser's new series of election briefs frame the challenges the heath care system faces, provide basic facts, and offer questions to assess the presidential candidates' plans on key health policy issues. Check back for more issue briefs.  Eliminating Racial/Ethnic Disparities in Health Care: What are the Options  Health Care Costs and Election 2008  Women's Health and Election 2008…

  • How Will The Uninsured Be Affected By Health Reform?

    Issue Brief

    This brief examines who the uninsured are and explores how they could be affected by health reform, including estimates of how many might qualify for coverage under a Medicaid expansion, how many would be eligible for subsidies and how many would not be eligible for such help. Issue Brief (.pdf)

  • Article and Policy Forum Examine Medicare, Health Reform and the Challenges Facing People With Disabilities

    Event Date:
    Event

    Wednesday, Sept. 8, the Foundation held a policy workshop examining Medicare, health reform and the challenges facing people with disabilities. Younger Medicare beneficiaries with disabilities are much more likely than seniors in the program to report problems accessing and paying for needed medical services, Kaiser Family Foundation researchers report in this Health Affairs article. Based on a national random-sample survey of people on Medicare, the study finds that half of nonelderly disabled beneficiaries report problems…

  • The Public’s Health Care Agenda for the 112th Congress

    Poll Finding

    Though the public remains divided on health reform overall, opposition to the new law ticked upward in January as Republicans ramped up efforts to repeal it, according to a survey conducted by researchers from the Kaiser Family Foundation and the Harvard School of Public Health. The survey also showed that there is no groundswell of public support for overturning the law, that many individual components of the legislation remain popular across the political spectrum and…

  • Controlling Health Insurance Premiums: Perspectives from the States, the Federal Government and Industry

    Event Date:
    Event

    The Affordable Care Act creates a process for states and the Department of Health and Human Services to review “unreasonable” premium increases and provide information to consumers about the process. The rules governing this rate review process went into effect September 1, 2011. This briefing by the Kaiser Family Foundation, held on September 22, 2011, addressed how these new rules might work and what the implications may be for the growth in health insurance premiums…

  • ¿Cubren los planes del mercado la atención médica de reasignación de género? ¿Qué cambios han habido en los requisitos de cobertura?

    FAQs

    No necesariamente. La cobertura varía según el estado y el plan. Algunos estados, pero no todos, prohíben que los planes médicos excluyan la cobertura de la atención de afirmación de género. Pero incluso en los estados donde la cobertura es obligatoria, es posible que no todos los servicios de afirmación de género estén cubiertos. Por ejemplo, un plan podría cubrir la terapia hormonal, pero no la depilación láser. En los estados donde no se exige…

  • Veo “planes catastróficos” que parecen incluso más económicos que otros planes del mercado. ¿Qué son? ¿Puedo comprar uno?

    FAQs

    Los planes catastróficos tienen los costos compartidos más altos y las primas más bajas. En 2026, los planes catastróficos tendrán un deducible anual de $10.600 para una persona o $21.200 para una familia. El plan no tiene que cubrir más de tres consultas de atención primaria antes de alcanzar el deducible. Los planes catastróficos solo se pueden vender a ciertas personas. Consulte estas preguntas frecuentes para obtener más información. Tenga en cuenta que si es…