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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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  • The Affordable Care Act’s Enduring Resilience

    Perspective

    In this article in the Journal of Health Politics, Policy and Law, Larry Levitt examines the Affordable Care Act 10 years after it's enactment. The article notes that the law has taken numerous blows, yet due to its policy design and the political forces it has unleashed, the law has shown remarkable resilience.

  • The Effects of Medicaid Expansion under the ACA: Studies from January 2014 to January 2020

    Report

    This literature review summarizes findings from 404 studies of the impact of state Medicaid expansions under the ACA published between January 2014 (when the coverage provisions of the ACA went into effect) and January 2020. It includes studies, analyses, and reports published by government, research, and policy organizations using data from 2014 or later. This body of research suggests that the expansion presents an opportunity for gains in coverage, improvements in access and financial security,…

  • New Interactive Map Offers State Data on What Democratic Primary Voters Say About Health Care

    News Release

    Democratic voters across the primary states that have already cast their ballots for the 2020 Democratic presidential nomination consistently name health care as the top issue or among the top issues in this year’s election. A new interactive map highlights what Democratic primary voters are saying about health care as they vote. Based on KFF’s analysis of the state-level AP VoteCast data collected in most states as they hold their primary elections, health care ranked…

  • POSTPONED – The ACA at 10: What We’ve Learned from the States and How the 2020 Elections Could Shape the Future

    Event Date:
    Event

    THIS EVENT HAS BEEN POSTPONED. This planned March 18 public forum organized by the Kaiser Family Foundation and the National Academy for State Health Policy public forum has been postponed. Additional information will be posted as it becomes available. The event would have featured two panel discussions examining the Affordable Care Act's impact on states and potential changes on the horizon. The first panel includes officials from five states and will explore how states approached…

  • Even Supporters May Not Understand Medicare-for-All

    From Drew Altman

    In this Axios column, Drew Altman shows that the majority of supporters don’t know how Medicare-for-all works, with both positive and negative implications for support if they knew more.

  • Tracking the Role of Health Care in the 2020 Election: What Do The Polls Tell Us

    Perspective

    In this February 2020 post for The JAMA Health Forum, Mollyann Brodie and Ashley Kirzinger examine the role health care has played in the primary election to date, what the polling data says about the issue, including Medicare-for-all and a public option, and what to expect from the issue during the rest of the 2020 election campaign.

  • Questions about Prescription Drug Importation? KFF Has Answers

    News Release

    With lowering prescription drug costs a top priority for Americans, the Trump Administration, presidential candidates, members of Congress, and several states are proposing to allow the importation of drugs from abroad, chiefly Canada. The idea of allowing drugs to be imported from Canada and other countries is popular with Americans across the political spectrum, but has yet to be implemented due to concerns about safety, and strong opposition from the drug industry. A new KFF…

  • Republican Voters Have Moved On from Hating the ACA

    From Drew Altman

    In this Axios column, Drew Altman analyzes KFF’s tracking poll and shows that the ACA is now yesterday’s issue for Republicans. They have shifted their sights to Medicare-for-all...at least for this election season.