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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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  • KFF Health Tracking Poll – January 2019: The Public On Next Steps For The ACA And Proposals To Expand Coverage

    Feature

    This month's KFF Health Tracking Poll finds that about four in ten are aware of the federal judge's ruling that the ACA is no longer valid but once made aware, most disapprove of the ruling. This poll also examines the public's favorability toward expanding the role of public health care programs, and majorities across partisan groups have a favorable opinion of programs such as Medicare buy-in and Medicaid buy-in, with a national Medicare-for-all being less…

  • Poll: Majorities Favor a Range of Options to Expand Public Coverage, Including Medicare-for-All

    News Release

    At a time when debate is beginning about a national Medicare-for-all plan and other approaches to expanding coverage through public programs, this month’s KFF Health Tracking poll examines Americans’ early opinion on a range of options under consideration. The poll finds majority support for four different approaches: 77 percent of the public, including most Republican (69%), favor allowing people between the ages of 50 to 64 to buy health insurance through Medicare; 75 percent, including…

  • Will the Iran Debate Defuse Partisan Battles Over Obamacare?

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman discusses whether the debate about the Iran deal may bring a respite for the Affordable Care Act from politics as usual, and how long it might last.

  • California’s Previously Uninsured After The ACA’s Second Open Enrollment Period

    Report

    The Kaiser Family Foundation California Longitudinal Panel Survey is a series of surveys that, over time, tracks the experiences and views of a representative, randomly selected sample of Californians who were uninsured prior to the major coverage expansions under the Affordable Care Act (ACA). The initial baseline survey was conducted with a representative sample of 2,001 nonelderly uninsured Californian adults in summer 2013, prior to the ACA’s initial open enrollment period. The second survey in…

  • 2015 Survey of Health Insurance Marketplace Assister Programs and Brokers

    Report

    This nationwide survey analysis of Marketplace consumer assistance programs and brokers examines the nature of Marketplace assistance during the second open enrollment period for 2015 coverage, and offers unique insights into how Affordable Care Act (ACA) implementation is progressing, what is changing, and what challenges remain. Building upon our Survey of Health Insurance Marketplace Assister Programs (2014), the analysis compares Assister Program capacity and experiences from the first open enrollment period to the next, and…

  • The Connection Between Health Coverage and Income Security

    From Drew Altman

    In this column in The Wall Street Journal's Think Tank, Drew Altman shows how expanding health coverage and improving economic security for working Americans are connected even though they are often part of separate policy debates.

  • The Connection Between Health Coverage and Income Security

    News Release

    Using data from a new Kaiser Family Foundation panel survey following the uninsured in California who gained coverage since 2010, Drew Altman's latest column in The Wall Street Journal's Think Tank shows how expanding health coverage and improving economic security for working Americans are connected even though they are often part of separate policy debates. All previous columns by Drew Altman are available online.

  • Racial and Ethnic Disparities in Access to and Utilization of Care among Insured Adults

    Issue Brief

    This analysis based on data from the 2014 Kaiser Survey of Low-Income Americans examines differences in access to and utilization of care for Black and Hispanic adults compared to White adults among those who are uninsured, enrolled in Medicaid, and privately insured. The findings suggest that gains in health coverage under the ACA will lead to improvements in access to care and utilization for White, Black, and Hispanic adults. They also highlight the importance of…

  • At CMS, the Mission Is Broader Than Medicare and Medicaid

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman discusses whether the Centers for Medicare and Medicaid Services' broad new responsibilities implementing the Affordable Care Act and a more proactive approach to Medicare payment signals that it’s time for (another) name change. All previous columns by Drew Altman are available online.