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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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  • Confusion Declines, but Remains Widespread in KFF May Tracking Poll

    Perspective

    Confusion over the new health reform law declined but remains widespread, with 44 percent of the public saying they were confused in May, compared to 55 percent in April. Moreover, more than a third of Americans (35%) say they do not understand what the impact of the law will be on themselves and their families, while 61 percent report feeling they do understand what that impact will be. Americans continue to report getting information about…

  • Insurance Coverage of Contraceptives

    Perspective

    In this post, we answer some of the key questions about the new contraceptive coverage policy generally, and more specifically, how it will be applied to religious organizations.

  • Transparency and Complexity

    Perspective

    This fall a new rule takes effect requiring all private health plans to offer a uniform, simple to read, summary of benefits and coverage (SBC).  The SBC will provide consumers with standardized information about how plans cover essential health benefits and what coverage limits and cost sharing applies. The SBC is one of the most popular provisions of the ACA.  Consumers often find health insurance difficult to understand and would no doubt welcome a plainly written…

  • KFF Data Note: A Snapshot of Public Opinion on the Individual Mandate

    Perspective

    This week, the Supreme Court hears arguments on several challenges to the Patient Protection and Affordable Care Act (ACA), including the provision that requires individuals to purchase health insurance as of 2014, known as the individual mandate. For the two years since the law’s passage, and during the debate leading up to it, this provision has been one of the most controversial aspects of the law. As the lawyers, policymakers, ACA opponents and supporters focus…

  • The Individual Mandate: How Sweeping?

    Perspective

    The so-called "individual mandate"  – the provision under the Affordable Care Act (ACA) that requires most individuals to carry a minimum level of insurance coverage and is now being considered by the Supreme Court – has emerged as the least popular element of the reform law and the prime target for its opponents. Yet in practice, the mandate may not be quite as far-reaching as the controversy over it suggests. The vast majority of Americans already…

  • Health Insurance Transparency under the Affordable Care Act

    Perspective

    In February, a final rule was issued implementing the Affordable Care Act (ACA) requirement that all health plans provide a uniform summary of coverage for all enrollees and applicants. The idea of providing easy-to-understand summaries of coverage is, in fact, the most popular provision in the ACA, according to a recent Kaiser tracking poll. That finding suggests powerful consumer frustration over the complexity of health insurance and the difficulty people face evaluating health insurance choices and understanding…

  • 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…

  • Nearly 9 Million Uninsured Americans Could Get Free or Subsidized Health Insurance if the Biden Administration Re-Opens ACA Marketplace Enrollment in Response to COVID-19

    News Release

    Four million uninsured people could get an ACA bronze plan with no premium payment and 4.9 million others could get subsidies to offset the cost of such a plan if the Biden Administration were to re-open ACA marketplace enrollment, a KFF analysis finds. Four million uninsured people could get an ACA bronze plan with no premium payment and 4.9 million others could get subsidies to offset the cost of such a plan if the Biden…

  • A Profile of Community Health Center Patients: Implications for Policy

    Issue Brief

    Community health centers are a key source of primary care in underserved areas. Their role will grow as coverage expands under the ACA. To sharpen understanding of the health center patient population, this brief compares them to the low-income population overall, using the Health Center Patient Survey and National Health Interview Survey. The pre-ACA profile of health center patients that emerges sets the stage for measuring change and highlights important implications of states’ Medicaid expansion…