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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

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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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  • A Reporter’s Guide to Supreme Court Arguments on Health Reform

    Event Date:
    Event

    The Alliance for Health Reform and the Robert Wood Johnson Foundation sponsored this reporters-only briefing to help journalists cover the Supreme Court arguments challenging the Patient Protection and Affordable Care Act and their aftermath with greater depth and understanding. Panelists focus on tips, story ideas and angles that have perhaps been underreported or overlooked, as well as angles for after the court ruling comes down, expected in June. The panel was co-moderated by Ed Howard…

  • An Update on CMS’s Capitated Financial Alignment Demonstration Model For Medicare-Medicaid Enrollees

    Issue Brief

    Beginning in January, 2013, the Centers for Medicare and Medicaid Services (CMS) will implement a three year multi-state demonstration to test new service delivery and payment models for people dually eligible for Medicare and Medicaid. These demonstrations will enroll full dual eligibles in managed fee-for-service or capitated managed care plans that seek to integrate benefits and align financial incentives between the two programs. On January 25, 2012, CMS issued a memorandum providing additional guidance for…

  • Kaiser Analysis: Estimated Health Insurance Rebates Under the Health Reform Law Total $1.3 Billion in 2012

    News Release

    NEWS RELEASEApril 26, 2012 Rebates Expected to Vary Significantly by State MENLO PARK, Calif. – Consumers and businesses are expected to receive an estimated $1.3 billion by this August in rebates from health insurers who spent more on administrative expenses and profits than allowed by the Affordable Care Act (ACA), finds a new analysis from the Kaiser Family Foundation of the latest estimates provided by insurers to state insurance commissioners. The rebates include $541 million…

  • Trends in Employer-Sponsored Insurance Offer and Coverage Rates, 1999-2014

    Issue Brief

    This issue brief uses data from the National Health Interview Survey (NHIS) to examine trends in employer-sponsored health insurance (ESI) for different of individuals and households in the United States. While ESI remains the leading source of coverage for nonelderly people, the percentage covered by an employer plan has declined over the past 15 years. A similar pattern exists with firm offer rates; fewer workers were offered health insurance from their employer in 2014 than…

  • Pulling It Together: Keeping the Health Reform Coalition Together

    Perspective

    We could be headed for a new schism in the debate about health reform. Not the familiar gulf between advocates of the market and government, or the predictable one between deficit hawks and spenders, but a new one that crosses traditional partisan and ideological lines between advocates of long-term reform of the health care delivery system, and immediate help for the uninsured and insured struggling with health care costs.  This new rift is most likely to develop if tight money and a crowded agenda…

  • Pulling it Together: What Will Health Reform Do For Me?

    Perspective

    There is one poll number that may be more important to watch than any other if we have a big debate about health reform: The percentage of Americans who think that they or their families would be better off if the president and the Congress enacted major health reform legislation. It's a number that signals whether people think that health reform legislation will actually help them with the problems they are having in the current…

  • Pulling it Together: 19.7

    Perspective

    Several years ago Joanne Silberner from NPR offered some advice I liked. Joanne said that the secret to effective communication was to "have a killer anecdote and a killer number." Here is a killer number: 19.7. That's the average number of years between major attempts at health reform since Harry Truman made health reform a top priority and his plan was branded a socialist plot and soundly defeated in 1950. The chart below chronicles the…

  • Pulling It Together: A Public Opinion Surprise

    Perspective

    Medicaid is the nation’s primary health insurance program for low-income people and people with disabilities, covering more than 60 million people this year.  And it's about to get a lot of attention: it's likely to be a prime target for spending reductions by "deficit hawks" in debate over the budget; governors are arguing that federal rules requiring them to maintain coverage under Medicaid tie their hands at a time when they are trying to crawl…

  • California's "Bridge to Reform" Medicaid Demonstration Waiver

    Fact Sheet

    This issue brief provides an overview of California's "Bridge to Reform" Medicaid Demonstration Waiver, which was approved in 2010 and will make up to roughly $8 billion in federal Medicaid matching funds available to California over a five-year period to expand coverage to low-income uninsured adults and preserve and improve the county-based safety-net. The waiver also allows the state to enroll Medicaid-eligible seniors and persons with disabilities into managed care plans that meet specified readiness…

  • Report Finds State Costs of Implementing The Affordable Care Act’s Medicaid Expansion Would Be Modest Compared to Increases in Federal Funds, and Some States Would See Net Savings

    News Release

    Washington, D.C. – A new report released today by the Kaiser Family Foundation shows modest state costs for implementing the Medicaid expansion under the Affordable Care Act compared to significant increases in federal funds, allowing some states to see net budget savings even as millions of low-income uninsured Americans gain health coverage. The new, updated analysis, conducted by John Holahan, Matt Buettgens, Caitlin Carroll and Stan Dorn at the Urban Institute for the Foundation's Commission…