Year in Review: 10 Health Policy Issues for 2023

Here’s a look back at 10 issues KFF tracked closely this year with some of our top findings summarized:

Health care costs continue to be a burden for many Americans: From our data showing that family health insurance premiums for employer coverage rose 7% to nearly $24,000 this year—and became unaffordable for many workers at small employers — to our series on “Dying Broke” focused on how older Americans struggle to pay for long-term care—the health care affordability crisis continues to plague Americans and remain a top issue going into the 2024 election. And, while anti-obesity drugs captured a lot of attention, coverage, cost, and access is unclear. More than 100 million people in America—41% of adults—have medical bills they can’t pay.

Access to Abortion and contraception remained top issues for voters following the Supreme Court’s decision to overturn Roe v. Wade last year. We tracked state abortion policies and litigation throughout the year, and also explored the right to contraception across the U.S. Our newsroom dove into how the issue is playing out nationally and in the states. Abortion also played a role in Congressional discussions about reauthorizing PEPFAR, the U.S.’ signature program to provide HIV prevention and treatment services to millions, saving more than 25 million lives over 20 years.

Medicaid enrollment began to dip, with further drops expected. Our annual survey of state Medicaid directors found that states expect national Medicaid enrollment will decline by 8.6% in state fiscal year 2024 as state Medicaid agencies continue to unwind pandemic-related continuous enrollment protections. As of Dec. 13, more than 12 million people have been disenrolled from Medicaid due to unwinding. Some subsequently regained coverage, so the net enrollment decline will be lower. At the same time, North Carolina just this month expanded their Medicaid programs to cover low-income adults, joining 39 other states and the District of Columbia.

Medicare drug price negotiations began, which were authorized as part of last year’s Inflation Reduction Act, but with significant debate by the drug industry. Medicare open enrollment concluded on Dec. 7, and we heard from Medicare beneficiaries about their views on marketing practices, looking for options, and their coverage. Many seniors let their plans renew automatically.

Covid was still a thing but Americans began to worry less about the pandemic, and their chances of getting sick, as our COVID-19 Vaccine Monitor showed. Interest in getting the latest booster waned even though most Black and Hispanic adults expected to get it while most White adults did not. Plus, following the end of the public health emergency declaration in May, finding a booster and paying for it was confusing for many, prompting a “cheat sheet” to help figure it out.

Misinformation continued to be prevalent across health issues, and KFF found that at least four-in-10 people say they’ve heard each of 10 specific false claims but relatively few believe those claims are definitely true. Most are simply uncertainty, which creates a “muddled middle,” that can be reached with reliable information from trusted sources, such as doctors and local television news.

Advancing health equity remains a top issue for health policy experts and researchers. New survey research from KFF showed that six-in-10 Black adults, about half of American Indian and Alaska Native and Hispanic adults, and four-in-10 Asian adults say they prepare for possible insults from providers or staff and/or feel they must be very careful about their appearance to be treated fairly during health care visits at least some of the time. KFF Health News also continued its coverage of how health outcomes differ based on race and ethnicity.

Everything old is new again? And, to close out the year, we heard from former President Trump and Gov. Ron DeSantis (R-FL), that they want to replace or alter the Affordable Care Act (ACA). KFF’s polling shows that Americans broadly support the ACA, with more than twice the share of Democratic voters (70%) than Republican voters (32%) saying it’s a very important issue for the candidates to discuss. Plus, there’s been record enrollment in the ACA marketplace this year. KFF Health News explored the issues in its “What the Health” podcast episode and in its summary of related media coverage.