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Affordable care act

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following Steep Climb

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.

The Average Marketplace Deductible Grew in 2026, With Shifts to Higher-Deductible Plans as Enhanced Credits Ended

The average Affordable Care Act Marketplace deductible experienced the steepest increase in history — growing by 37% or over $1,000, from $2,759 in 2025 to $3,786 in 2026 as enhanced premium tax credits expired, according to a new KFF analysis. After the enhanced tax credits ended, many Marketplace shoppers shifted toward lower-premium, higher-deductible plans.

An image of text is an excerpt from Cynthia Cox's quick take which reads, "While the Trump administration attributes this drop in enrollment to their attempts to address fraud, this coverage loss happened at the same time millions of people faced steep increases in their premium payments — often in the double or even triple digits — with the expiration of enhanced tax credits."

ACA Marketplace Enrollment Is Down By 3 Million After Big Jump in Premium Payments

Enrollment dropped 13% following the expiration of enhanced premium tax credits at the beginning of this year. Enrollment fell from a high of 22.1 million people in 2025 to 19.2 million people in February 2026. While the Trump administration attributes this drop in enrollment to their attempts to address fraud, this coverage loss happened at the same time millions of people faced steep increases in their premium payments – often in the double or even triple digits – with the expiration of enhanced tax credits.

medicaid

About the Medical Frailty Exemption to Medicaid Work Requirements

States’ Differing Plans for Implementing Medicaid Work Requirements

Mapping the High Unemployment Hardship Exception to Medicaid Work Requirements

An image of text is an excerpt from Jennifer Tolbert's quick take which reads, "While a temporary period of allowing people to self-attest to their compliance with work requirements will ease the effects for some, the more restrictive definition of medical frailty adopted by the Trump Administration will be challenging for states to implement and could lead to more people falling through the cracks and losing coverage."

CMS Requires More Restrictive Definition of Medical Frailty in New Medicaid Work Requirements Rule

On June 1, the Centers for Medicare and Medicaid Services issued an interim final rule on Medicaid work requirements that adopts a restrictive definition of medical frailty — differing from states’ early expectations. KFF’s Jennifer Tolbert explains why the more restrictive definition of medical frailty adopted by the Trump Administration will be challenging for states to implement and could lead to more people falling through the cracks and losing coverage.

State Policy Decisions on Work Requirements Implementation

KFF’s interactive Medicaid work requirements tracker includes new county-level unemployment data by state, showing which counties meet the high unemployment thresholds and how many expansion enrollees in those counties may be exempt from work requirements.

policy spotlight

Explore the Basics of U.S. Health Policy

Health Policy 101 is a comprehensive guide covering fundamental aspects of U.S. health policy and programs, including Medicare, Medicaid, the Affordable Care Act, employer-sponsored insurance, racial and ethnic disparities, and more. The chapters can be downloaded in a PDF format for faculty and student use, and the information will be updated annually or as data and circumstances change.