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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.

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

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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  • State Marketplace Profiles: Rhode Island

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    Final update made on October 8, 2013 (no further updates will be made)  Establishing the Marketplace After the legislature failed to pass Marketplace legislation during the 2011 session, Governor Lincoln Chafee (I) signed Executive Order 11-09 on September 19, 2011, to establish the Rhode Island Health Benefit Exchange.1  In July 2013, Rhode Island announced that its Marketplace would be called HealthSource RI.2  Recommendations by the Rhode Island Healthcare Reform Commission largely informed the Governor’s decision to…

  • State Marketplace Profiles: Illinois

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    Final update made on October 15, 2013 (no further updates will be made) Establishing the Marketplace While Governor Pat Quinn (D) had considered establishing a state-based marketplace via executive order, he began moving in the direction of a state-federal partnership marketplace in July 2012.1 ,2  While the state has established a Partnership Marketplace, the administration still intends to transition to a fully State-based Marketplace in 2015 and will continue with the necessary planning. Illinois will be…

  • State Exchange Profiles: Indiana

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    Final update made on December 13, 2012 (no further updates will be made)  Establishing the Exchange In November 2012, Governor-elect Mike Pence (R) announced that he would not move forward with setting up a state-based health insurance exchange when he takes office in 2013.1 During his term, Governor Mitch Daniels (R) had signed Executive Order #11-01 in 2011 to conditionally establish and operate the Indiana Insurance Market, Inc., a nonprofit corporation to serve as the…

  • State Exchange Profiles: New Jersey

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    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: Oklahoma

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    Final update made on December 13, 2012 (no further updates will be made) Establishing the Exchange  On November 19, 2012, Governor Mary Fallin (R) announced that Oklahoma would not pursue the creation of a state-based health insurance exchange.1 Prior to the announcement, Oklahoma had established the Joint Committee on Federal Health Care Law to explore the state’s options regarding federal health reform, including exchange implementation in the state.2 The Joint Committee convened in 2011 and released final exchange…

  • State Exchange Profiles: Georgia

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    Final update made on December 11, 2012 (no further updates will be made) Establishing the Exchange On November 16, 2012, Governor Nathan Deal (R) announced that the Georgia had stopped planning for an exchange.1 In the previous year Governor Deal issued an Executive Order to create the Georgia Health Exchange Advisory Committee to assess whether and how Georgia should establish a health benefit exchange.2 The 25-member Committee included state officials, insurers, brokers, business representatives, consumers, and providers.3 The…

  • State Marketplace Profiles: California

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    Final update made on November 26, 2013 (no further updates will be made) Establishing the Marketplace On September 30, 2010, former Governor Arnold Schwarzenegger (R) signed into law two complementary bills, AB 1602 and SB 900, to establish the California Health Benefit Exchange. California was the first state in the nation to pass legislation creating a health insurance Marketplace after the enactment of federal health reform.1   Current Governor Jerry Brown (D) called a special legislative…

  • State Exchange Profiles: Pennsylvania

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    Final update made on December 12, 2012 (no further updates will be made) Establishing the Exchange On December 12, 2012, Governor Tom Corbett (R) notified federal officials that Pennsylvania would default to a federally-facilitated health insurance exchange.1 Prior to the announcement, the Pennsylvania Insurance Department had taken the lead with exchange planning. The Insurance Department, released an extensive report in November 2011 that suggested broad support for a state-run exchange.2 In January 2012, the Department released…

  • State Exchange Profiles: Texas

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    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…

  • State Marketplace Profiles: Idaho

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    Final update made on October 3, 2013 (no further updates will be made) Establishing the Marketplace On December 11, 2012, Governor C.L. Otter (R) announced Idaho’s commitment to the establishment of a State-based health insurance Marketplace and on March 28, 2013 signed into law legislation (HB248) creating the Idaho Health Insurance Exchange.1 2  In August 2013, the state announced that the online marketplace would be called Your Health Idaho.3  While the Governor had previously signed an Executive…