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The ACA Marketplace

2025 KFF Marketplace Enrollees Survey

About one in three ACA enrollees said they would be “very likely” to look for a lower-premium Marketplace plan If their premium payments doubled, according to a KFF survey conducted in 2025.

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Tracking the Public’s Views on the ACA

While overall opinion of the Affordable Care Act has been more favorable than unfavorable since 2017, there remain deep partisan divides. See how public opinion on the ACA has changed from the inception of the law to the present. This interactive tool highlights key moments when views shifted and trends based on party identification, income, age, gender, and race/ethnicity.

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  • What Happens to Medicaid Drug Policy if the ACA is Overturned?

    Issue Brief

    The repeal of the ACA could mean loss of Medicaid coverage for up to 15 million that were enrolled in the ACA Medicaid expansion group prior to the COVID-19 pandemic; however, repeal could also mean significant changes to Medicaid prescription drug policy with implications for state and federal spending for prescription drugs for non-expansion Medicaid enrollees.

  • State Exchange Profiles: Montana

    Other Post

    Final update made on April 19, 2013 (no further updates will be made) Establishing the Exchange In December 2012, Montana’s elected State Auditor Monica Lindeen (D) confirmed that the federal government would operate a health insurance exchange in Montana.1 The previous year, two proposed bills (HB620 and HB124) to establish a health insurance exchange in Montana failed.2,3 Instead, the legislature passed SB 228, a bill that would prohibit the creation of a health insurance exchange as proscribed…

  • State Exchange Profiles: Tennessee

    Other Post

    Final update made on December 10, 2012 (no further updates will be made) Establishing the Exchange On December 10, 2012, Governor Bill Haslam (R) announced Tennessee would default to a federally-facilitated health insurance exchange.1 Prior to the announcement that the state would not operate its own exchange, the Tennessee Department of Finance and Administration established the Insurance Exchange Planning Initiative to advise the Governor and Legislature on exchange implementation. The Initiative worked closely with a…

  • State Marketplace Profiles: Iowa

    Other Post

    Final update made on November 18, 2013 (no further updates will be made) Establishing the Marketplace On December 14, 2012, Governor Terry Branstad (R) informed federal officials that Iowa would pursue a State-federal Partnership Marketplace.1  Iowa will assume plan management functions in the Marketplace and will continue to perform Medicaid and CHIP eligibility determinations. The state intends to transition to a fully State-based Marketplace in 2016. Contracting with Plans: The Iowa Insurance Department (IID) is responsible…

  • State Marketplace Profiles: Hawaii

    Other Post

    Final update made on November 6, 2013 (no further updates will be made)  Establishing the Marketplace On July 11, 2011, Governor Neil Abercrombie (D) signed SB 1348 into law establishing the Hawaii Health Connector, a State-based health insurance Marketplace.1  The law builds on Hawaii’s Prepaid Health Care Act of 1975 (PHCA) which required nearly all employers to provide health insurance to employees working 20 or more hours a week for four consecutive weeks.2  Structure: The legislation established the…

  • State Exchange Profiles: Maine

    Other Post

    Final update made on April 2, 2013 (no further updates will be made)  Establishing the Exchange On November 16, 2012, Governor Paul LePage (R) wrote in a letter to federal officials that Maine would not be pursuing efforts to implement a state-based health insurance exchange.1 Legislation establishing a state-run health insurance exchange failed to pass in 2011 and 2012. Prior to ending planning efforts, the Governor created an exchange Advisory Committee in July 2011, which included…

  • State Exchange Profiles: South Carolina

    Other Post

    Final update made on December 10, 2012 (no further updates will be made) Establishing the Exchange On November 15, 2012, Governor Nikki Haley (R) informed federal officials South Carolina would default to a federally-operated health insurance exchange.1 This decision was largely based on findings from the South Carolina Health Planning Committee which had concluded the state cannot implement a state-based exchange as required by the Affordable Care Act (ACA) and should instead encourage the establishment of…

  • State Exchange Profiles: New Jersey

    Other Post

    Final update made on December 10, 2012 (no further updates will be made) Establishing the Exchange  On December 7, 2012, Governor Chris Christie (R) vetoed A 3186/S 2135, which would have established a health insurance exchange within the Department of Banking and Insurance and announced that the state would default to a federal exchange.1Governor Chris Christie (R) vetoed similar legislation earlier in 2012.2 In 2011, the New Jersey Interagency Working Group on the ACA, led…

  • 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…

  • High Health-Care Prices: More Talk Than Action  

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman explores how price is the major factor that distinguishes the cost of our health care system from those in other developed nations, yet most efforts in the U.S. to address health-care costs don't focus on price much at all. All previous columns by Drew Altman are available online.