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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

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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  • Wisconsin’s BadgerCare Program and the ACA

    Fact Sheet

    This fact sheet provides an overview of changes to BadgerCare, Wisconsin's 1115 waiver demonstration project, and how it relates to the Affordable Care Act's Medicaid expansion.

  • Kaiser Health Tracking Poll: February 2014

    Feature

    The February 2014 Kaiser Health Tracking Poll finds that those who are most likely to be customers in the Affordable Care Act (ACA)’s new insurance exchanges (the uninsured and those who purchase their own coverage) are more likely to prefer less costly plans with narrow provider networks over more expensive plans with broader networks, while the public overall has the opposite preference. Overall opinion of the ACA remains about the same as it has been…

  • Consumer Assets and Patient Cost Sharing

    Issue Brief

    Higher cost sharing in private insurance has been credited with helping to slow the growth of health care costs in recent years. For families with low incomes or moderate incomes, however, high deductibles, out-of-pocket limits and other cost sharing can be a potential barrier to care and may lead these families to significant financial difficulties. This issue brief uses information from the Federal Reserve Board's 2013 Survey of Consumer Finances to look at how household…

  • Medicare Spending Cuts and Hospital Productivity Gains

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman and guest co-author Dana Goldman examine hospital productivity gains, and what they may mean for hospitals’ ability to absorb spending reductions.

  • Insurance Markets in a Post-King World

    Perspective

    This perspective addresses how insurance markets might respond if the US Supreme Court sides with the plaintiffs in the King v. Burwell case. The case challenges the legality of premium and cost-sharing subsidies for low- and middle-income people buying insurance in states where the federal government rather than the state is operating the marketplace under the Affordable Care Act (ACA).

  • ACA 101: What You Need To Know

    Event Date:
    Event

    On Friday, March 6, 2014, the Kaiser Family Foundation and the Alliance for Health Reform hosted an ACA 101 briefing on the Affordable Care Act. The briefing took place just as the second marketplace enrollment period ended, and the Supreme Court heard oral arguments in a case challenging the ACA's subsidies (King v Burwell).

  • If Health Insurance Subsidies Are Struck Down, States Will Need Time

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman explores a practical timetable for state action if the Supreme Court rules in favor of the plaintiffs in King V. Burwell and ponders what Republicans in Congress might do.

  • At Five Year Anniversary of the ACA, Gap Between Favorable and Unfavorable Views Among The Public Narrows to Smallest Spread in More Than Two Years

    News Release

    Most Expect Negative Consequences if Supreme Court Prohibits Subsidies in States Without Their Own Insurance Exchanges; Two Thirds of the Public and Those in Affected States Want Congress or Their State to Close Any Gaps As April 15 Tax Deadline Nears, Nearly Half Unaware Insurance Reporting Requirement Starts This Year Five years after President Obama signed the Affordable Care Act, this month's Kaiser Health Tracking Poll finds the closest split between favorable and unfavorable views…

  • New Analysis: Half of U.S. Households Eligible for a Tax Subsidy Under the Health Law Would Owe a Repayment, While 45 Percent Would Receive a Refund

    News Release

    Estimated Average Repayment is $794. Estimated Average Refund is $773. Half of U.S. households eligible for a 2014 tax subsidy under the Affordable Care Act would owe a repayment to the government, while 45 percent would receive a refund, according to estimates from a new analysis by the Kaiser Family Foundation. The analysis – which is a simulation based on historical patterns of income volatility among all households eligible for ACA premium subsidies -- estimates that the…