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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

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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  • Pulling it Together: The Health Care Industry’s Second Voluntary Effort

    Perspective

    The announcement that health care industry groups plan to put on the table voluntarily a package of proposals to shave $2 trillion off the rate of increase in health spending over the next ten years immediately conjures up the image of the Voluntary Effort or VE launched with similar fanfare in the Carter administration.  Back then the industry used the VE to fend off Jimmy Carter's efforts to aggressively control the costs of hospital care…

  • Explaining Health Care Reform: What is Health Insurance?

    Issue Brief

    A key element in any comprehensive health reform plan is defining what health insurance is and the amount of insurance coverage people will have. There are two components to that coverage: the types of services covered (e.g., physician care, hospitalization, prescription drugs, etc.), and the cost sharing required of enrollees (e.g., the annual deductible, the copayments or coinsurance, and the maximum out-of-pocket costs for a year). The overall approach to reform drives the kinds of…

  • Health Reform: Lessons From Massachusetts

    Event Date:
    Event

    As Congress debates comprehensive national health reform, the Kaiser Family Foundation has two reports and an updated fact sheet that examine state-level health reform in Massachusetts and the lessons it offers for policymakers in Washington. Consumers’ Experience in Massachusetts: Lessons For National Health Reform and In Pursuit of Affordable Health Care: On the Ground Lessons from Families in Massachusetts, examine the impact of health reform on the lives of ordinary people in the state, including…

  • Oral Histories: Report From a Dental Fair for Uninsured Adults

    Report

    This report profiles patients attending a dental fair in rural Virginia to highlight the impact of lack of coverage for oral health services on adults. Uninsured adults have vast oral care needs, and untreated dental problems can have serious health, employment and social consequences, highlighting the relationship between inadequate benefits and unmet health needs. Report (.pdf)

  • Pulling it Together: Simple Arithmetic

    Perspective

    This week we put out our annual benchmark survey of employer health coverage and costs. Two numbers jumped off the pages. The first number was the average cost of a family health insurance policy in 2009: $13,375. To put that number in context, if you are an employer, you can hire an employee at the minimum wage for about $15,000 per year. If you are a consumer, you can rent an average two-bedroom apartment nationwide…

  • Immigrants’ Health Coverage and Health Reform: Key Questions and Answers

    Issue Brief

    As health reform discussions continue, there has been some focus on health coverage for immigrants and how immigrants will be treated under reform plans being considered on Capitol Hill. This issue brief provides an overview of key questions related to immigrants' health coverage and health reform, addressing subjects such as how immigrants receive health coverage, how many of the uninsured are non-citizen immigrants and what would happen to coverage for non-citizen immigrants under current health…

  • Medicaid and CHIP Health Reform Implementation Timeline

    Issue Brief

    This timeline highlights the implementation dates for provisions in the new health reform law that are related to Medicaid and the Children's Health Insurance Program. While major expansions of Medicaid are set to occur in 2014, many other key provisions in the health reform law become effective between 2010 and 2014. Timeline (.pdf)

  • Uninsured and Untreated: A Look at Uninsured Adults Who Received No Medical Care for Two Years

    Issue Brief

    With Medicaid set to expand under health reform, the program will begin to reach individuals who have previously had little interaction with the health care system. The data in this brief profile uninsured adults with incomes at or below 133 percent of the poverty level who, because of health reform, will be eligible for Medicaid in 2014 based on income. It focuses on those who received no medical care over a two-year period to help…

  • Pulling it Together: Seniors and Health Reform

    Perspective

    It is widely believed that seniors are antsy about the new health reform law. And there is heightened interest in how seniors feel about the law in the political world because they are more likely to vote in midterm elections.  About 48% of the electorate said they voted in the 2006 midterms while about 63% of seniors said the same.  Our June and July tracking polls shed light on seniors’ views on health reform and…

  • To Hospitalize or Not to Hospitalize? Medical Care for Long-Term Care Facility Residents

    Report

    To Hospitalize or Not to Hospitalize? Medical Care for Long-Term Care Facility Residents This report explores factors that appear to drive relatively high rates of hospitalizations, based on interviews with doctors, nursing home staff and families in four cities. Key factors include liability concerns, limited onsite staff capabilities, difficulty reaching residents' physicians for care instructions on nights and weekends, better and more timely access to diagnostic tests in hospitals, and patient preferences. Physicians with patients…