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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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  • In Focus: Listening to Enrollees with Affordable Care Act Coverage Who Voted for Trump

    News Release

    As Republicans in Washington pursue efforts to repeal and replace the Affordable Care Act, what do enrollees in ACA marketplaces and state Medicaid expansions who voted for President Trump want in a health care plan? The Kaiser Family Foundation asked some of them in six focus groups convened in December in Michigan, Ohio, and Pennsylvania -- three with Trump voters enrolled in the ACA marketplaces and three with Trump voters in Medicaid. Focus group participants…

  • Where President-elect Donald Trump Stands on Six Health Care Issues

    Issue Brief

    Where does President-elect Donald Trump stand on key health care issues? This snapshot outlines his positions and policy statements during the campaign on issues such as health insurance, the ACA, Medicaid, Medicare, the opioid epidemic, prescription drug costs, and women's reproductive health.

  • A Tale of Two Siblings, the ACA, and the Supreme Court

    From Drew Altman

    In a column published on The Huffington Post, Kaiser Family Foundation President and CEO Drew Altman shows how the U.S. Supreme Court’s decision to make the ACA Medicaid expansion a state option has upended the health insurance system for low and moderate income people in many states and discusses how the states and federal government can address the problem.

  • The Health-Cost Problem Is Coming Back

    From Drew Altman

    Drew Altman, in The Wall Street Journal’s Think Tank, discusses how the conversation will soon shift back to health-care costs from health coverage, because they are rising more sharply again. And as the discussion turns back, he says that because there is no national agreement on a strategy to address increasing costs, current efforts in the public and private sector, however fragmented and uncoordinated, will need to step up their game.

  • What happens after the COBRA subsidies end in September?

    FAQs

    You can continue on COBRA unsubsidized until your 18 months of COBRA eligibility ends. In addition, you will have the option to enroll in marketplace coverage when the subsidy ends in September.  Loss of the COBRA subsidy will make you eligible for a special enrollment period (SEP) to sign up for marketplace coverage.  If you make your plan selection before the end of September, new marketplace coverage will take effect on October 1. 

  • Two-Thirds of the Public Say the U.S. Should Play a Major Role in Distributing COVID-19 Vaccines Globally, But Not Most Republicans

    News Release

    With increased attention to the global need for COVID-19 vaccines and the Biden administration’s announcement today about how it plans to distribute the first portion of the 80 million doses it will share by the end of this month, the latest KFF Health Tracking Poll finds that two-thirds of the public (66%) say that the U.S. should play at least a “major role” in distributing COVID-19 vaccines to other countries, including about a quarter (27%)…

  • More Than Meets the Eye: Long-Term Care Provisions in the New Reform Law

    Event Date:
    Event

    In the debates around the health reform law and its implementation, little attention has been given to the law's provisions supporting long-term care. This briefing offered an overview of these provisions, such as the CLASS Act, a new national, voluntary insurance program to help working adults finance services and supports that they may need in the future, and the Community First Choice Option, which helps Medicaid recipients get attendant care at home. This October 1…