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Affordable Care Act

The ACA MarketplaceS

How Has Marketplace Enrollment Changed Across States in 2026?

Following several years of rapid enrollment growth in the ACA Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the enhanced tax credits, generally saw lower drops in enrollment.

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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  • Insurer Rebates under the Medical Loss Ratio: 2012 Estimates

    Report

    Beginning in 2011, the Affordable Care Act (ACA) requires insurance plans to pay out a minimum percentage of premium dollars towards health care expenses and quality improvement activities, limiting the amount spent on administrative and marketing costs and profit. Under the law, large group plans are required to spend at least 85 percent of premium dollars on health care and quality improvement, while small group plans must spend at least 80 percent. These ratios are…

  • Health Reform and the Art of Federalism

    Perspective

    The U.S. Department of Health and Human Services (HHS) recently announced significant changes to the premiums charged in the Pre-existing Condition Insurance Plan (PCIP), aka the "high risk pool" created by the Affordable Care Act. Premiums will now be up to 40% lower depending on the state (in some states the cost to enrollees is unchanged), and application procedures will be eased. The PCIP plans provide coverage for people who cannot buy coverage in the…

  • July Kaiser Health Tracking Poll: A Focus On The Mandate and the Medicaid Expansion in the Aftermath of the Supreme Court Decision

    Perspective

    This second July poll reports in further depth on public opinion about the Affordable Care Act (ACA) in the wake of the Supreme Court decision. The Supreme Court’s decision that the individual mandate was constitutional as a tax appears to have had little impact on opinion about the already largely unpopular requirement that most people have health coverage or potentially face a penalty. Sixty-six percent of the public view the mandate negatively when it is…

  • The Language of Health Care Reform

    Perspective

    Published in the Jan. 19 edition of JAMA, this article from KFF Executive Vice President for Health Policy Larry Levitt lays out the major health policy challenges that will confront President-elect Biden and potential approaches to major reform.While a big reform debate may not be likely this year, one is likely coming as the nation will need to confront much higher costs than in other high-income countries, worse outcomes in many cases, tens of millions…

  • The Numbers Behind “Young Invincibles” and the Affordable Care Act

    Perspective

    As enrollment statistics in the new health insurance marketplaces start to become available, there is a growing focus on whether the enrollment of so-called “young invincibles” will be sufficient to keep insurance markets stable. Enrollment of young adults is important, but not as important as conventional wisdom suggests since premiums are still permitted to vary substantially by age. Because of this, a premium “death spiral” is highly unlikely. Why does the age distribution of enrollees…

  • Can We Learn From ACA Implementation and Improve the Law?

    From Drew Altman

    Senator Baucus made headlines recently when he predicted a “train wreck” for Obamacare. David Brooks predicted “chaos” in a recent column. In a news conference, the President offered a different perspective.  “There’ll still be, you know, glitches and bumps…. That’s pretty much true of every government program that’s ever been set up,” Obama said. “But if we stay with it, and we understand what our long-term objective is, which is making sure that in a…

  • States’ Participation in Six Key Medicaid Long-Term Services and Supports Options Provided or Enhanced by the Affordable Care Act

    Feature

    States’ Participation in Six Key Medicaid Long-Term Services and Supports Options Provided or Enhanced by the Affordable Care Act Download Source M. O’Malley Watts, M. Musumeci, and E. Reaves, How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports (LTSS) Today? State Adoption of Six LTSS Options, The Henry J. Kaiser Family Foundation, April 2013, available at: http://www.kff.org/medicaid/issue-brief/how-is-the-affordable-care-act-leading-to-changes-in-medicaid-long-term-services-and-supports-ltss-today-state-adoption-of-six-ltss-options/;  updates available at: http://www.kff.org/state-category/health-reform/.

  • Obamacare y Usted: Si usted es una mujer

    Fact Sheet

    Como mujer, es especialmente importante para usted entender cómo la Ley de Cuidado de Salud a Bajo Precio (Affordable Care Act o ACA, en inglés) cambiará el cuidado de salud en el 2014. Su atención médica necesita diferenciarse de la de los hombres y a menudo usted es la que toma las decisiones sobre el cuidado de salud de su familia. Obamacare amplía la variedad de muchos servicios que son importantes para las mujeres, y…