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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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  • No Easy Choices: 5 Options to Respond to Per Capita Caps

    Issue Brief

    Under a per capita cap, per enrollee spending would be capped, but the total amount of federal dollars to states could vary with enrollment changes and states would not be able to impose enrollment caps. Faced with restrictions in federal financing, states would have to make hard choices. This brief outlines the key measures states could use to manage their budgets and the associated challenges under a per capita cap: raise taxes or make other…

  • Favorability of the Affordable Care Act Tops 50%, While Across Many Measures, Majorities Oppose the Republican Plan to Replace It

    News Release

    Three-Quarters of the Public, Including Most Republicans, View Medicaid Favorably; Most Oppose Federal Funding Cuts to States As the Senate prepares to vote on the Republican bill to repeal and replace the Affordable Care Act and cap federal Medicaid funding, a new Kaiser Family Foundation Tracking Poll finds most Americans oppose the Republican plan and many of its key provisions. A majority of Republicans, however, continue to support the Republican plan, though by a significantly…

  • Ten Ways That the House American Health Care Act Could Affect Women

    Issue Brief

    In this brief, the Kaiser Family Foundation outlines 10 ways women could be affected under the House of Representatives’ American Health Care Act. In particular, the brief analyzes how changes might affect Medicaid and its expansion population, financial assistance in the individual insurance market, coverage for essential health benefits and preventive services such as contraception, abortion, and maternity care, as well as insurance reforms such as gender rating.

  • Visualizing Health Policy: Eligibility and Coverage Trends in Employer-Sponsored Health Insurance

    News Release

    This Visualizing Health Policy infographic looks at eligibility and coverage trends in employer-sponsored health insurance. Between 2000 and 2015, the share of workers covered by health benefits offered by their employers dropped from 63 percent to 56 percent, with some firms not offering coverage and some employees not enrolling when coverage is offered. The biggest decrease occurred among employees working for small firms (3-199 workers). Among people younger than 65, those with lower incomes continued to…

  • Survey Finds Most Marketplace Enrollees Like Their Coverage, Though Satisfaction with Premiums and Deductibles Has Declined Since 2014

    News Release

    Following the Affordable Care Act’s (ACA) third open enrollment period, a new Kaiser Family Foundation survey of people who buy their own health insurance finds most marketplace enrollees give their coverage good marks, though concerns about premiums, deductibles, and other costs have risen since 2014. The survey, the third in a series, finds about two thirds (68%) of marketplace customers rate their current coverage as either “excellent” or “good.” Although concerns about narrow network plans…

  • How has the ACA Medicaid Expansion Affected Providers Serving the Homeless Population: Analysis of Coverage, Revenues, and Costs

    Issue Brief

    To further understand how the first full year of Medicaid expansion has affected patients who are homeless and the providers who care for them, this analysis uses data from the Uniform Data System (UDS) for health centers to examine changes in insurance coverage, revenues and costs among Health Care for the Homeless (HCH) projects serving the homeless population.