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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.

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

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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  • Back to the Future? A look back at High-Risk Pools

    Quick Insights

    Sen. Vance suggested moving higher-risk individuals to different insurance risk pools than healthier ones... What could such a policy mean for health coverage and costs?

  • Again, No Medicaid

    From Drew Altman

    In his latest column, KFF President and CEO Drew Altman explains why Medicaid, despite former President Donald Trump's silence on the topic, warrants greater attention given the potential for drastic changes or cuts to it should Republicans win control in the election.

  • Medical Debt: The Canary in the Coal Mine for Health Care Affordability

    Perspective

    With Vice President Harris promising to address medical debt as part of her economic plan, KFF Executive Vice President for Health Policy Larry Levitt explores why it is a symptom of the broader problem of affordable health care and reviews recent efforts to address it in this JAMA Health Forum post.

  • A Look at State Efforts to Ban Cellphones in Schools and Implications for Youth Mental Health

    Issue Brief

    Education leaders and policymakers are turning to cellphone bans in schools to help address youth mental health concerns and improve learning, an idea that has largely received bipartisan support. Cellphone ban legislation has had a resurgence following advisories from the U.S. Surgeon General on youth mental health and the impacts of social media. Research on the effectiveness of these bans, however, is limited, and challenges with implementation and enforcement remain.

  • How Narrow or Broad Are ACA Marketplace Physician Networks?

    Report

    This report examines the share of doctors participating in the provider networks of Qualified Health Plans (QHPs) offered in the individual market in the federal and state Marketplaces in 2021, and how network breadth affected costs for enrollees.

  • KFF Analysis Finds Physician Networks in ACA Marketplace Plans Vary Widely, and Enrollees Typically Pay More in Premiums to Access Broader Networks

    News Release

    A KFF analysis of physician networks in the Affordable Care Act’s Marketplace plans finds wide variations in the share of local practicing physicians who participate, with the least costly plans generally having a smaller share of physicians than more expensive plans. The analysis examines the breadth of physician networks listed in Marketplace plan directories in 2021 in nearly every county nationally in relation to the number of actively practicing physicians locally.  On average, Marketplace enrollees…

  • Compare the Candidates on Health Care Policy

    Feature

    The side-by-side comparison tool provides a quick overview of former President Trump's and Vice President Harris' records, positions, public statements, and proposed policies on a range of key health care topics.