Affordable Care Act

The ACA Marketplace

2025 KFF Marketplace Enrollees Survey

In 2025, about one in three ACA enrollees said they would be “very likely” to look for a lower-premium Marketplace plan If their premium payments doubled.

Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees

Following the expiration of the enhanced premium tax credits for people with Affordable Care Act (ACA) Marketplace plans, a new KFF follow-up survey of the same Marketplace enrollees KFF surveyed in 2025 finds half (51%) of returning enrollees say their health care costs are “a lot higher” this year compared to last year, including four in 10 who specifically say their premiums are “a lot higher.”

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  • State Marketplace Profiles: Iowa

    Other Post

    Final update made on November 18, 2013 (no further updates will be made) Establishing the Marketplace On December 14, 2012, Governor Terry Branstad (R) informed federal officials that Iowa would pursue a State-federal Partnership Marketplace.1  Iowa will assume plan management functions in the Marketplace and will continue to perform Medicaid and CHIP eligibility determinations. The state intends to transition to a fully State-based Marketplace in 2016. Contracting with Plans: The Iowa Insurance Department (IID) is responsible…

  • State Marketplace Profiles: Hawaii

    Other Post

    Final update made on November 6, 2013 (no further updates will be made)  Establishing the Marketplace On July 11, 2011, Governor Neil Abercrombie (D) signed SB 1348 into law establishing the Hawaii Health Connector, a State-based health insurance Marketplace.1  The law builds on Hawaii’s Prepaid Health Care Act of 1975 (PHCA) which required nearly all employers to provide health insurance to employees working 20 or more hours a week for four consecutive weeks.2  Structure: The legislation established the…

  • State Exchange Profiles: Maine

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    Final update made on April 2, 2013 (no further updates will be made)  Establishing the Exchange On November 16, 2012, Governor Paul LePage (R) wrote in a letter to federal officials that Maine would not be pursuing efforts to implement a state-based health insurance exchange.1 Legislation establishing a state-run health insurance exchange failed to pass in 2011 and 2012. Prior to ending planning efforts, the Governor created an exchange Advisory Committee in July 2011, which included…

  • State Exchange Profiles: Arizona

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    Final update made on December 4, 2012 (no further updates will be made) Establishing the Exchange  On November 28, 2012, Governor Jan Brewer (R) informed federal officials that Arizona would default to a federally-facilitated health insurance exchange.1 Prior to her decision to default, the Governor had established the Office of Health Insurance Exchange to “organize the health insurance marketplace for easier evaluation by individuals and small businesses to acquire affordable health insurance.”2 While legislation establishing a…

  • State Exchange Profiles: South Carolina

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    Final update made on December 10, 2012 (no further updates will be made) Establishing the Exchange On November 15, 2012, Governor Nikki Haley (R) informed federal officials South Carolina would default to a federally-operated health insurance exchange.1 This decision was largely based on findings from the South Carolina Health Planning Committee which had concluded the state cannot implement a state-based exchange as required by the Affordable Care Act (ACA) and should instead encourage the establishment of…

  • State Exchange Profiles: New Jersey

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    Final update made on December 10, 2012 (no further updates will be made) Establishing the Exchange  On December 7, 2012, Governor Chris Christie (R) vetoed A 3186/S 2135, which would have established a health insurance exchange within the Department of Banking and Insurance and announced that the state would default to a federal exchange.1Governor Chris Christie (R) vetoed similar legislation earlier in 2012.2 In 2011, the New Jersey Interagency Working Group on the ACA, led…

  • State Exchange Profiles: North Carolina

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    Final update made on February 12, 2013 (no further updates will be made)  Establishing the Exchange On November 15, 2012, Governor Beverly Perdue (D) declared the state’s intent to establish a state-federal partnership health insurance exchange.1 However, on February 12, 2013, newly-elected Governor Pat McCrory (R) issued a statement indicating that North Carolina will abandon efforts to establish a partnership exchange and will instead allow the federal government to operate the exchange.2 In 2011, Governor Perdue had…

  • State Exchange Profiles: Texas

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    Final update made on December 11, 2012 (no further updates will be made) Establishing the Exchange On July 9, 2012, Governor Rick Perry (R) announced that Texas would not establish an exchange.1 Prior to this announcement, the Department of Insurance and the Health and Human Services Commission had partnered to explore exchange implementation plans.2 Using federal grant funding they identified subcontractors to assist with the exchange planning process, to collect stakeholder feedback, and to investigate the state’s…

  • State Exchange Profiles: Florida

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    Final update made on December 14, 2012 (no further updates will be made) Establishing the Exchange In December 2012, Governor Rick Scott (R) announced that Florida would not be pursuing efforts to implement a state-based health insurance exchange.1 Governor Scott has been a vocal opponent of federal health reform and the state has refused multiple funding opportunities available through the Affordable Care Act (ACA).2 Florida was also the lead plaintiff in a lawsuit brought by 26 states…

  • High Health-Care Prices: More Talk Than Action  

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman explores how price is the major factor that distinguishes the cost of our health care system from those in other developed nations, yet most efforts in the U.S. to address health-care costs don't focus on price much at all. All previous columns by Drew Altman are available online.