Affordable Care Act

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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  • Who Are the 2018 Health Care Voters?

    Interactive

    This interactive allows users to examine the demographic profile of health care voters and compare them to voters who do not feel as strongly about a candidate’s position on health care.

  • Poll: Two-thirds of Americans Don’t Want the Supreme Court to Overturn Roe v. Wade

    News Release

    Large Majority of the Public View Federal Funding of Family Planning Services for Low-Income Women as “Important” As President Trump prepares to make a new Supreme Court nomination, new polling from the Kaiser Family Foundation finds that two-thirds (67%) of the public do not want the Supreme Court to overturn the 1973 landmark Roe v. Wade decision that established women’s constitutional right to abortion. Fielded this month prior to Justice Anthony Kennedy’s retirement announcement, the poll finds about three…

  • Survey: Adjusting to Sudden Reduction in Federal Funds, ACA Navigators Expect to Decrease Services

    News Release

    Many navigator organizations responsible for helping consumers understand and sign up for health coverage in 2018 Affordable Care Act (ACA) marketplaces say steep federal funding reductions that recently took effect will likely force them to limit their geographic service area, cut back outreach and public education, lay off staff members, and curtail other assistance, according to a new Kaiser Family Foundation survey of such programs. The navigators’ planned adjustments are in response to the government’s…

  • How People Get Covered

    Feature

    How-People-Get-Covered-HEALTHREFORM Download Source Kaiser Family Foundation  

  • State Exchange Profiles: Texas

    Other Post

    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…

  • Explaining Health Reform: How will the Affordable Care Act affect Small Businesses and their Employees?

    Fact Sheet

    Several provisions of the Affordable Care Act (ACA) will likely have significant effects on small businesses, their employees, and families. Currently, smaller businesses are less likely to offer health insurance coverage to their employees than larger companies: 57% of small businesses with 50 or fewer workers offered health benefits to employees, compared to 92% of businesses with 51 to 100 workers, and 97% of businesses with 101 or more workers in 2011.1  This fact sheet explains…

  • Providing Outreach and Enrollment Assistance: Lessons Learned from Community Health Centers in Massachusetts

    Issue Brief

    As states and communities gear up to provide outreach and enrollment assistance under the ACA, the enrollment assistance experience of health centers in Massachusetts, where a major expansion of health coverage was implemented six years ago, offers valuable lessons that can help to inform current and emerging efforts by health centers and other community-based organizations to reach and enroll millions of low-income, uninsured Americans in health insurance.