Update on Midterm Elections: Developments in the Affordable Care Act Marketplaces

By
kffcarenec
October 6, 2026

Kaiser Family Foundation

Overview

In 2025, ACA Marketplace enrollment peaked at 21.8 million, driven by enhanced premium tax credits. However, the expiration of these credits in 2026 led to significant enrollment declines and increased costs for consumers.

Background

The Affordable Care Act (ACA) Marketplaces provide essential health insurance options for individuals without other coverage. Understanding the dynamics of enrollment and premium costs is critical for assessing the ACA's impact on public health and access to care. Recent legislative changes and economic factors have introduced challenges that could affect future enrollment and marketplace stability.

Data Highlights

In 2025, effectuated enrollment reached 21.8 million. Following the expiration of enhanced tax credits, premium costs rose by 114% for many enrollees in 2026.

Key Findings

Enrollment in ACA Marketplaces decreased by nearly three million individuals from 2025 to 2026.
Premium amounts owed after tax credits increased by over $1,000 annually for many enrollees in 2026.
Insurers requested a median premium hike of approximately 15% for 2027.
Some insurers plan to withdraw from ACA markets, affecting participation and stability.
Public sentiment toward the ACA remains favorable, though divided by partisan affiliation.

Clinical Implications

Healthcare professionals should be aware of the increasing costs associated with ACA Marketplace coverage and the potential impact on patient access to insurance. The changes in enrollment and premium structures may influence patient decisions regarding health coverage.

Conclusion

The ACA Marketplaces face significant challenges following the expiration of enhanced tax credits, leading to increased premiums and declining enrollment.