This brief provides estimates of Marketplace coverage among parents and children in recent years from two nationally representative surveys. We also assess coverage among parents by state Medicaid expansion status and differences in health care access and utilization among parents and children by coverage status. 

Why This Matters

Several policy changes between 2019 and 2025 affected the affordability of Marketplace coverage and access to Medicaid, including the passage of the American Rescue Plan Act in 2021, which expanded the size and reach of premium tax credits to improve the affordability of Marketplace plans. Marketplace enrollment surged under these changes. However, Marketplace enrollment is projected to fall under the 2025 budget reconciliation law, and the fate of the enhanced premium tax credits is currently being debated, with risks of substantial drops in Marketplace coverage among both children and adults if they expire.

What We Found

Marketplace coverage has become an increasingly important part of the health insurance landscape for families with children since 2019, especially for parents and particularly parents in states that have not adopted the Affordable Care Act’s Medicaid expansion. 

• In 2025, 4.8 percent of parents and 3.4 percent of children had Marketplace coverage according to the Current Population Survey, and 5.9 percent of parents and 3.1 percent of children had Marketplace coverage in 2024 according to the National Health Interview Survey.
• Children and parents account for approximately 4 in 10 of all nonelderly Marketplace enrollees, according to both data sources we examined.
• Reliance on Marketplace coverage among parents increased more between 2019 and 2025 in Medicaid nonexpansion states than in expansion states. Among parents, Marketplace coverage was a much more important coverage source in nonexpansion states than in expansion states in 2025.
• Among people with incomes between 100 and 400 percent of the federal poverty level, access to health care and use of health care services for Marketplace-enrolled parents and children were similar to those of comparable people with employer-sponsored insurance and better than those of similarly situated uninsured people, suggesting more families will go without the care they need if Marketplace coverage declines and they become uninsured.

How We Did It

We use data from the 2019–24 National Health Interview Survey and the 2019–25 Current Population Survey Annual Social and Economic Supplement to assess Marketplace coverage for parents ages 19 to 64 and children age 18 and younger. We also analyze Marketplace plan selections during open enrollment using administrative data from the Centers for Medicare & Medicaid Services.