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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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  • One Year Since Dobbs: The Landscape of Abortion Policies Across the US  

    News Release

    There has been intense focus on abortion policies across the United States since the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization on June 24, 2022. That decision overturned Roe v. Wade, eliminating federal constitutional protections for abortion and putting the decision to restrict or protect abortion with the states.  Now, nearly one year later, what is the status of federal and state developments? Where is abortion banned? Where is litigation pending? And…

  • Me faltan algunos años para cumplir 65 años y ser elegible para Medicare, y mientras tanto me gustaría inscribirme en un plan del mercado de seguros. Soy inmigrante, residente legal, y he oído que hay u...

    FAQs

    En general, los inmigrantes con estatus legal (excepto los beneficiarios de DACA) pueden adquirir un plan en el mercado de seguros establecidos por la Ley de Cuidado de Salud a Bajo Precio (ACA). La nueva ley no afecta la elegibilidad para la cobertura del mercado de seguros para estos inmigrantes. Actualmente, dependiendo de sus ingresos y el tamaño de su hogar, podría ser elegible para subsidios para compensar el costo de sus primas. Sin embargo,…

  • Approved Changes in Indiana’s Section 1115 Medicaid Waiver Extension

    Issue Brief

    On February 1, 2018, the Centers for Medicare and Medicaid Services (CMS) approved an amended extension of Indiana’s Healthy Indiana Program 2.0 (HIP 2.0) Section 1115 demonstration waiver. Indiana’s waiver initially implemented the ACA’s Medicaid expansion from February, 2015 through January, 2018 by modifying Indiana’s pre-ACA limited coverage expansion waiver (HIP 1.0). Unlike other states that implemented the ACA’s Medicaid expansion through a waiver, Indiana’s demonstration also changes the terms of coverage for non-expansion adults…

  • 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…

  • Building an Information Technology Foundation for Health Reform: A look at Recent Guidance and Funding Opportunities

    Issue Brief

    The major coverage provisions in the Affordable Care Act (ACA) go into effect in January 2014 with an expansion of Medicaid eligibility to nearly all individuals under 138% of poverty and new subsidies for individuals with incomes between 138% and 400% of poverty to purchase coverage in newly established Health Insurance Exchanges. The ACA envisions a streamlined and simplified application process with seamless transitions between coverage in the Exchange and Medicaid. Using a web portal,…

  • Public Reporting of Quality Outcomes: What’s the Best Path Forward?

    Event Date:
    Event

    The Affordable Care Act aims to promote higher quality care in part by rewarding – and eventually requiring – the reporting of certain quality measures. Previous efforts suggest that public reporting can add significant value. Yet there are concerns about the best way to measure outcomes and quality, the possible unintended effects of public reporting, and whether purchasers and consumers actually use the information to make choices. Panelists at this April 27 briefing co-sponsored by…

  • Inside Deficit Reduction: What Now?

    Event Date:
    Event

    The Budget Control Act of 2011 tasked members of a "Super Committee" to find at least $1.2 trillion in deficit reduction over the next decade. Members did not reach an agreement by the November 23 deadline and as a result automatic spending cuts to defense and entitlement programs are set to kick in beginning in January 2013. Panelists at this briefing discussed the impact the sequester will have on the health care sector and how…

  • Briefing, Survey Examine 2012 Data From 50-State Survey of Medicaid and CHIP Eligibility and Enrollment Policies

    Event Date:
    Event

    Despite continued tight state budgets, a requirement in the Affordable Care Act (ACA) that states maintain eligibility in Medicaid and Children’s Health Insurance Programs was central in preserving coverage during 2011. In addition, more than half of states (29) made improvements in their programs, often using technology to increase program efficiency and streamline enrollment. These and other findings appear in the Kaiser Commission on Medicaid and the Uninsured report, "Performing Under Pressure: Annual Findings of…

  • Quality Care for Less Money: Can Regional Successes Go National?

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    Event

    On February 15, the Kaiser Family Foundation hosted an event featuring a PBS documentary with former Washington Post correspondent T.R. Reid – U.S. Health Care: The Good News – which explores efforts to provide low-cost, quality health care in the U.S. The film looks at variations in health spending across the country and showcases efficient health care delivery systems, like Grand Junction in Colorado and Group Health in Seattle, suggesting that these communities demonstrate that…

  • Understanding Health Insurance

    Video

    The YouToons help consumers understand health insurance by explaining health insurance premiums, out-of-pocket costs, and provider networks. These three videos are excerpts from the 2014 YouToons video, Health Insurance Explained – The YouToons Have It Covered.