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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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  • How Will the Uninsured in Colorado Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Colorado, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Colorado are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Connecticut Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Connecticut, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Connecticut are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Kansas Fare Under the Affordable Care Act?

    Fact Sheet

    The 2010 Affordable Care Act (ACA) has the potential to extend coverage to many of the 47 million nonelderly uninsured people nationwide, including the 369,000 uninsured Kansans. The ACA establishes coverage provisions across the income spectrum, with the expansion of Medicaid eligibility for adults serving as the vehicle for covering low-income individuals and premium tax credits to help people purchase insurance directly through new Health Insurance Marketplaces serving as the vehicle for covering people with…

  • How Will the Uninsured in Montana Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Montana, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Montana are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Oregon Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Oregon, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Oregon are eligible for Medicaid or financial assistance in…

  • Does the Affordable Care Act Cover the Uninsured?

    From Drew Altman

    Drew Altman, in The Wall Street Journal's Think Tank, discusses what a new Foundation survey finds about one of the biggest questions about the Affordable Care Act: whether it covers the uninsured.

  • New Kaiser Survey of People with Non-Group Insurance Finds Nearly Six in 10 People Enrolled in Marketplace Plans Were Previously Uninsured

    News Release

    People in ACA-Compliant Plans Are Somewhat More Likely To Say They Are in Fair or Poor Health Than Those in Non-Compliant Plans People Who Switched Plans Due to Cancellation Notices or Other Reasons Are As Likely To Say Their Premiums Went Down As Went Up Overall About As Many People in This Market Feel They Benefited From the ACA As Feel Negatively Impacted, With Variations By Sub-Group The first in a series of new surveys…

  • Issue Brief Explores Consequences of Potential Supreme Court Decisions on the ACA Contraceptive Coverage Requirement

    News Release

    A new Kaiser Family Foundation issue brief explores some of the factors influencing employers’ coverage decisions and possible consequences for employers and workers that could arise from possible Supreme Court decisions in the cases brought by Hobby Lobby and Conestoga Wood Specialties, for-profit corporations challenging the Affordable Care Act’s requirement to cover contraceptive services and supplies in health insurance. Other resources about the Supreme Court case are also available online.

  • Visualizing Health Policy: Understanding the Effect of Medicaid Expansion Decisions in the South

    Other Post

    This Visualizing Health Policy infographic examines the effect of decisions by states in the South to implement or forgo the Affordable Care Act Medicaid expansion. It shows that Southerners are more likely than people living in other parts of the United States to be uninsured; that most Southern states have poverty rates above the national average; that without the Medicaid expansion (which most Southern states are not implementing), Medicaid eligibility levels for adults in the South remain…

  • On Medicaid Expansion, Red States Will Be Watching Red States

    From Drew Altman

    This was published as a Wall Street Journal Think Tank column on June 30, 2014. Since the Supreme Court made expanding Medicaid optional for states under the Affordable Care Act, 26 states have expanded Medicaid. Three of the 24 states that have not–Indiana, Utah and Pennsylvania–are considering expanding via federal waivers that they are negotiating with the Obama administration. In Virginia, the newly elected Democratic governor is looking for a way around opposition from the Republican-controlled legislature,…