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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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  • A Challenge for States: Assuring Timely Access to Optimal Long-Term Services and Supports in the Community

    Issue Brief

    The Medicaid program is a major payer for long-term services and supports (LTSS) in the United States, accounting for 40 percent of total spending for long-term services and supports. The federal government has played an active role in sponsoring initiatives to promote a shift to community-based care; and evidence from several states suggests that providing care in the community can be less expensive than providing institutional care. The Affordable Care Act (ACA) provides incentives for…

  • Uniform Coverage Summaries for Consumers

    Issue Brief

    This brief explains the proposed federal rule that requires private health plans to provide a short, easy-to-read uniform summary of benefits and coverage to all health insurance applicants and enrollees. The rule, which implements a provision in the Affordable Care Act (ACA), is intended to make it simpler for consumers to compare health plans before they enroll and understand their coverage once they are enrolled. Currently, consumers in employer-sponsored plans receive summaries of their benefits,…

  • The Fraying Link Between Work and Health Insurance: Trends in Employer-Sponsored Insurance for Employees, 2000-2007

    Report

    This analysis shows that employer-sponsored coverage began declining after 2000 due to an economic downturn that saw rising unemployment, declining family incomes and more workers moving into temporary work, part-time work and other employment arrangements where health benefits were not provided. Employer-sponsored coverage continued to decline after 2003 despite improvements in the economy and slower growth in health care costs. The decline in coverage was due both to falloffs in the share of employees with…

  • Policy and Political Implications of the Supreme Court Case on the Affordable Care Act

    Event Date:
    Event

    This webcast features a Kaiser Family Foundation briefing held on March 14, 2012, examining the policy and political implications of the pending U.S. Supreme Court case on the Affordable Care Act (ACA). At the briefing, the Foundation released new polling data on the public’s views about the case as well as their more general views about the health reform law. Participants included: Kaiser President and CEO Drew Altman (moderator)Joe Onek, Principal, The Raben Group Sheila…

  • Pulling It Together: Moving Away From Employer Based Coverage: Don’t Forget Public Opinion

    Perspective

    One of the underlying big issues in the unfolding health reform debate is whether most Americans should continue to get insurance through work where they get it today, or purchase it themselves in the individual private health insurance marketplace. Senator McCain promotes moving to individual insurance and having individuals rather than employers make coverage decisions, as has President Bush.  But this is not only a conservative idea.  Many on the liberal side -- such as…

  • Pulling It Together: What Conservatives Won In Health Reform (And Don’t Seem to Know It)

    Perspective

    Conservatives obviously don't like what they call "Obamacare" because they think it expands the role of government too much and spends too much money.  But ironically, the Affordable Care Act (ACA) actually promotes -- though not explicitly -- something that has been a fundamental objective of conservatives in health care for years: high-deductible health plans with more "skin in the game." In a new study we just released, we commissioned three different actuarial consulting firms…

  • How Is The Primary Care Safety Net Faring in Massachusetts? Community Health Centers In The Midst of Health Reform

    Report

    This report examines how community health centers, which provide comprehensive primary care for low-income and uninsured patients, have fared under Massachusetts' health reform law. Community health centers saw a significant increase in patient load amid the state's efforts to improve health coverage by expanding public programs and making private insurance more affordable. That experience shows that community health centers play a critical role in caring for newly insured patients while continuing to serve as the…

  • Coverage of Preventive Services for Adults in Medicaid

    Issue Brief

    This brief highlights data from a survey of coverage of 42 recommended preventive services for adults in Medicaid fee-for-service programs as of October 2010. Medicaid programs must cover preventive services for children as part of the Early Periodic Screening, Diagnosis and Treatment (EPSDT) benefit, but generally are not required to cover such services for adults. The Affordable Care Act (ACA) provides states the opportunity to earn a one percentage point increase in their federal matching…

  • ¿Quién es elegible para recibir subsidios para las primas?

    FAQs

    Los subsidios para las primas están disponibles para ciudadanos estadounidenses y ciertos inmigrantes con residencia legal que adquieran cobertura en el mercado de seguros y cuyos ingresos sean al menos iguales al 100% del Nivel Federal de Pobreza (FPL) ($15.650 para un adulto soltero o $32.150 para una familia de cuatro) en 2026. Actualmente, los subsidios para las primas también están disponibles para inmigrantes con residencia legal con ingresos inferiores a $15.650 (100% del FPL…