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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  • Web Briefing: What Worked, What’s Next? Strategies in Four States Leading ACA Enrollment Efforts

    News Release

    On Monday, July 28 from 1 p.m. to 2:00 p.m. EDT, the Kaiser Family Foundation will hold an interactive web briefing to examine the experiences and lessons of four states - Colorado, Connecticut, Kentucky, and Washington - that each established state-based Marketplaces, expanded their Medicaid programs, and successfully enrolled eligible individuals into Medicaid and Marketplace coverage under the ACA. The briefing will draw upon a new issue brief released today by the Foundation’s Kaiser Commission…

  • How Obamacare’s Progress Makes Expanding Coverage Harder

    From Drew Altman

    This was published as a Wall Street Journal Think Tank column on July 21, 2014. The Affordable Care Act’s success meeting its initial enrollment goals and the repair of HealthCare.gov seem to have calmed the political waters for Obamacare. But the job of enrolling the uninsured gets harder, not easier, because the remaining uninsured will generally be tougher to reach. Recent surveys show, roughly in line with expectations, that 8 million to 9.5 million fewer adults are uninsured compared with last year before…

  • On Health Care, Conservatives Protest Too Much

    From Drew Altman

    Lately conservatives have been feeling like losers in health care and complaining loudly about it. They don't like Obamacare or the increase in the government's role in health care or the federal spending it brings with it, even if those things result in coverage for more than 30 million uninsured Americans and new protections from the worst abuses in the health insurance industry. Actually, conservatives are winning at least as much as they are losing…

  • How Obamacare Is Doing Better But Feeling Worse

    From Drew Altman

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman explains why even as there are recent positive indicators of the Affordable Care Act’s performance and impact, public opinion about the law has not changed since passage of the law.

  • Sen. Mark Pryor Spotlights the Health Law’s Rx for Pre-Existing Illnesses

    From Drew Altman

    In a column for The Wall Street Journal’s Think Tank, Drew Altman explains why Senator Mark Pryor’s new campaign ad features the Affordable Care Act’s protections for people with pre-existing medical conditions, the somewhat forgotten “mega provision” of the law.

  • Covering The ACA May Be Almost As Hard As Implementing It

    From Drew Altman

    This Pulling It Together was adapted from a column I published earlier this week in Politico, with a new introduction added. You can read the original Politico column here. The implementation of the ACA is news and the public will demand information about it. Journalists and news organizations have an obligation to cover this story.  As Kaiser CEO I serve as the publisher of our non-profit news service, Kaiser Health News, and also as the head…

  • A Discussion with Leading Medicaid Directors: As FY 2013 Ends, Looking toward Health Care Reform Implementation in 2014

    Issue Brief

    The Kaiser Commission on Medicaid and the Uninsured convened a focus group discussion with Medicaid directors who serve on the Board of the National Association of Medicaid Directors (NAMD). The discussion focused on state progress and concerns about implementing the ACA including eligibility system changes and state action on the Medicaid expansion decision as well as activity around payment and delivery system reform, and other budget and enrollment trends. The discussion took place in May…