News Release

Poll: Trust and Confidence in the CDC Remain at Low Point After Changes to Recommended Childhood Vaccines; More Say the Changes Will Hurt than Help Children’s Health

New KFF Data Interactive Tracks Polling on Health Information and Trust

Published: Feb 6, 2026

In the weeks after the Trump administration reduced the number of recommended childhood vaccines for routine use, the public’s trust in the Centers for Disease Control and Prevention (CDC) remains at its lowest point, a new KFF Poll on Health Information and Trust finds.

Fewer than half (47%) now say that they trust the agency at least “a fair amount” to provide reliable vaccine information, similar to the share who said the same in September, but down more than 10 percentage points since the beginning of the second Trump administration, and continuing a downward trend first measured during the COVID-19 pandemic.

The recent decline reflects falling confidence among Democrats. Slightly more than half (55%) of Democrats now say they trust the CDC on vaccines, down from 64% September. About 4 in 10 Republicans say they trust the CDC for vaccine information, similar to the share who said the same a few months ago and in 2023, but fewer than half as many as said they trusted the CDC on the coronavirus back in 2020.

“Six years ago, 85% of Americans, and 90% of Republicans, trusted the CDC. Now less than half trust the CDC on vaccines,” KFF President and CEO Drew Altman said. “The wars over COVID, science, and vaccines have left the country without a trusted national voice on vaccines, and that trust will take time to restore.”

Line chart showing that trust in the CDC as an information source has declined from 2000 to 2026 amid changing partisan views.

Findings from the latest KFF Tracking Poll on Health Information and Trust, and more than a dozen previous polls, are now available on a new interactive dashboard tracking the public’s trusted sources for health information, attitudes toward vaccines, and use of news, social media, and AI for health-related information.

The dashboard provides visual representations of the key trends in the public’s trust in health information and tracks exposure to and belief in false and unproven health claims. The downloadable data and charts allow researchers, policymakers, journalists, and others to explore partisan and demographic differences on key health information issues. The dashboard will be updated regularly.

Awareness of and Views toward Changes in Recommended Childhood Vaccines

The latest poll finds that among those who have heard about the recent changes to the recommended childhood vaccine schedule, more say they expect the changes to have a negative impact than a positive one on children’s health.

About half of the public (51%), and a similar share of parents (52%), say they’ve heard at least some about the federal government’s recent changes to the recommended childhood vaccine schedule. This group, by a 2-1 margin, say the changes will have a negative impact on children’s health (54%) rather than a positive one (26%). The same is true among parents who heard about the changes, with a larger share saying the changes will negatively impact children’s health (47%) than have a positive impact (29%).

Democrats and independents largely expect the changes to hurt children’s health, while Republicans and supporters of the “Make America Healthy Again” (MAHA) movement largely expect it to improve children’s health.

Amid recent changes, confidence remains high across the public and parents in the safety of the MMR and polio vaccines, two longstanding childhood vaccines that continue to be recommended for routine use. This includes at least 3 in 4 Democrats, independents, Republicans, parents, and MAHA supporters.

But fewer are confident in the safety of the vaccines that are no longer universally recommended, and there are larger partisan differences.

  • Majorities of the public are also confident in the safety of the hepatitis B (70%) and flu (65%) vaccines for children, and just under half (48%) are confident in the safety of the COVID-19 vaccine. The recent changes removed these three vaccines from the routine recommended childhood vaccine schedule.
  • Partisans are divided on their views of the three vaccines removed from the federal recommended vaccine schedule, with Democrats being more likely than Republicans to express confidence in their safety. The partisan gap is widest for the COVID-19 vaccine, with about eight in ten Democrats confident in their safety, nearly three times the share of Republicans who say the same (79% vs. 28%). Democrats are also more likely than Republicans to be confident in the safety of flu (82% vs. 52%) and hepatitis B vaccines (85% vs. 61%).

Designed and analyzed by public opinion researchers at KFF, this survey was conducted January 13-20, 2026, online and by telephone among a nationally representative sample of 1,426 U.S. adults in English and in Spanish. The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on other subgroups, the margin of sampling error may be higher.

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Craig Palosky

Poll Finding

KFF Tracking Poll on Health Information and Trust: Trust in the CDC and Views of Federal Childhood Vaccine Schedule Changes

Published: Feb 6, 2026

News Release: Poll: Trust and Confidence in the CDC Remain at Low Point After Changes to Recommended Childhood Vaccines; More Say the Changes Will Hurt than Help Children’s Health

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Findings

Key Takeaways

  • In the weeks following the Trump administration’s announcement of changes to the recommended childhood vaccine schedule, the public’s trust in the CDC remains at its lowest point since the COVID-19 pandemic, including a 9-percentage point drop among Democrats in recent months saying they trust the CDC for reliable vaccine information. Just over half (55%) of Democrats and fewer Republicans (43%) and independents (46%) now say they trust the agency for vaccine information. In addition, fewer than half of adults (44%) express confidence in U.S. federal health agencies to make recommendations about the childhood vaccine schedule.
  • Among the half of U.S. adults who report hearing about the recent changes to the childhood vaccine schedule, more say the changes will have a negative impact (54%) on children’s health than a positive one (26%). Partisans are split, with most Democrats who are aware of the change saying it will have a negative impact on children (83%, or 63% of all Democrats), while Republicans are more likely to say it will have a positive impact (47% of Republicans who are aware of the change, or 34% of all Republicans). About one in five Republicans who are aware of the changes say they will negatively impact children’s health and an additional one in five say they are not sure.
  • At least eight in ten U.S. adults across partisans and parents are confident – including about half who of adults who are “very confident” – in the safety of measles, mumps, and rubella (MMR) and polio vaccines, two longstanding childhood vaccines that continue to be recommended as routine. Majorities of adults are also confident in the safety of two of the vaccines that are no longer universally recommended for children following recent changes, hepatitis B (70%) and flu (65%), though fewer are “very confident,” and views are somewhat divided along partisan lines. Fewer (48%) adults are confident in the safety of COVID-19 vaccines for children, including just one in four who are “very confident.” Partisan divisions are sharpest when it comes COVID-19 vaccines, with just three in ten Republicans compared to eight in ten Democrats expressing confidence that they are safe for children.

Confidence and Trust in Federal Health Agencies

In January, the U.S. Centers for Disease Control and Prevention (CDC) announced the Trump administration’s major changes to the federally recommended vaccination schedule for children. This change – along with changes that started in October 2025 – reduces the number of diseases targeted for routine vaccination from 17 to 11, positioning the U.S. as an outlier among peer nations.1 In the weeks following this change, the latest KFF Tracking Poll on Health Information and Trust finds that the public’s trust in the CDC remains at its lowest level since the beginning of the COVID-19 pandemic. Fewer than half (47%) of the public says they have a “great deal” or “fair amount” of trust in the CDC to provide reliable information about vaccines.

Trust among Democrats has declined by nine percentage points since September 2025 (from 64% to 55%) and is down sharply from 88% in September 2023. About four in ten Republicans (43%) and half of independents (46%) say they trust the CDC for reliable information about vaccines, similar to the shares who said the same in September of last year.

Line chart showing rates of U.S. adult trust in the CDC for information on vaccines spanning from September 2023 to January 2026.

One year into President Trump’s second term, fewer than half of adults are confident in federal health agencies like the CDC and the U.S. Food and Drug Administration (FDA) to carry out some of their responsibilities, including making recommendations for children’s vaccines. Most adults (56%) say they have “little” to “no confidence” in federal health agencies to make recommendations about childhood vaccine schedules, including three in ten (29%) who have no confidence “at all.” Just over four in ten have “a lot” (15%) or “some” (29%) confidence in the agencies’ ability to do this.

About half of Democrats (51%) say they have at least “some” confidence in government health agencies to make recommendations about childhood vaccine schedules, compared to fewer Republicans (40%). Forty-five percent of independents say they are confident in government health agencies to make these recommendations, while 55% say they have “a little” confidence or “none at all.”

Mirroring Republicans, fewer than half of supporters of the Make America Healthy Again (MAHA) movement say they trust U.S. federal health agencies to make recommendations about vaccine schedules (45%). Overall, 45% of U.S adults say they are supporters of the MAHA movement, and this group is largely made up of Republicans and Republican leaners (65%) and Make America Great Again (MAGA) supporters (53%).

Stacked bar chart showing percent who say they have a lot, some, a little, or no confidence at all in the federal government health agencies to make recommendations about childhood vaccine schedules. Results shown by total adults, party ID, and support for the Make America Healthy Again movement.

This limited confidence extends beyond childhood vaccine recommendations to other core responsibilities of federal health agencies. Fewer than half of the public have at least “some” confidence in the agencies to ensure safety and effectiveness of vaccines approved for use in the U.S. (46%), make decisions based on science rather than the personal views of agency officials (38%), or act independently, without interference from outside interests (34%).

Democrats have more confidence than Republicans in these agencies to ensure vaccine safety and effectiveness (55% of Democrats vs. 45% of Republicans) and act independently, without outside interference (41% of Democrats vs. 33% of Republicans). Similar minorities of Democrats (44%) and Republicans (40%) express confidence in federal health agencies to make decisions based on science rather than personal views of agency officials.

Split bar chart showing percent who say they have a lot or some confidence in federal government health agencies to ensure the safety and effectiveness of vaccines, make decisions based on science, and act independently. Results shown by total adults and party identification.

KFF’s latest Tracking Poll on Health Information and Trust finds that a majority of the public continue to disapprove of Robert F. Kennedy Jr.’s job performance as Health and Human Services (HHS) Secretary and his handling of U.S. vaccine policy. About four in ten (44%) say they approve of his handling of his job as HHS Secretary, compared to over half who say they disapprove (55%). Similarly, about four in ten (43%) approve of Kennedy’s handling of U.S. vaccine policy while nearly six in ten (57%) disapprove. This is a slight change from September when 37% approved of his handling of vaccine policy, but views remain sharply divided along partisan lines, with large shares of Democrats disapproving and large shares of Republicans approving. Among supporters of the MAHA movement, about seven in ten approve of Kennedy’s job performance overall (72%) and his handling of vaccine policy (69%).

Stacked bar chart showing percent who say they strongly approve, somewhat approve, somewhat disapprove, or strongly disapprove of the way Robert F Kennedy Jr is handling his job and U.S. vaccine policy. Results shown by tota adults, party identification, and support for the Make America Healthy Again movement.

About half of the public, and a similar share of parents, say they have heard “a lot” (14%) or “some” (38%) about the federal government’s recent changes to the recommended childhood vaccine schedule. The other half report limited awareness, including three in ten who have not heard much (28%) and one in five who have heard “nothing at all” (21%).

Among those who have heard at least “some” about the changes, reactions tilt negative but are more positive among Republicans and MAHA supporters. For example, among the half of the public who have heard about the recent changes to the childhood vaccine recommendations, twice as many say the change will have a negative impact on children’s health (54%) as say it will have a positive impact (26%). Views of how the change will impact children is divided among partisans, with about eight in ten Democrats who are aware of the change saying it will negatively impact children’s health (83%, or 63% of total Democrats). Nearly half of Republicans who are aware of the change say it will have a positive impact (47%, or 34% of total Republicans). About one in five Republicans who have heard about the change say it will either have a negative impact (23%) or aren’t sure of the impact it will have (20%).

Again, mirroring views of Republicans overall, about half of MAHA supporters who are aware of the changes say they will positively impact children’s health (51%, 33% of total MAHA supporters), compared to one in five who say it will have a negative impact on children’s health.

Stacked bar chart showing percent who say the federal government's updates to the childhood vaccine schedule will have a negative impact, a positive impact, or no impact on children's health in the U.S. Results shown by total adults, total parents, party identification, and support for the Make America Healthy Again movement.

In a statement made about the change, Health Secretary Kennedy predicted it would “rebuild trust in public health.” However, those who are aware of recent changes to the federal vaccine recommendations are also nearly four times as likely to say that the change makes them less trusting of federal health agencies such as the FDA and CDC (53%) rather than more trusting (14%), while one-third of this group (33%) say the change does not make a difference in their trust.

Supporters of the MAHA movement have mixed reactions. Similar shares of MAHA supporters who are aware of the change say it makes them trust federal agencies more (28%) or less (27%), while at least four in ten (45%) say this does not affect their level of trust. Partisans are divided, with most Democrats who are aware of the change saying it makes them less trusting of federal health agencies (80%) while about half of Republicans saying it does not impact their trust.

Stacked bar chart showing percent who say changes to the recent childhood vaccine schedule makes them trust federal health agencies more, less, or it does not make a difference. Results shown by total adults, total parents, party identification, and support for the Make America Healthy Again movement.

Confidence in Safety of Vaccines for Children

While large majorities of adults are confident in the safety of several vaccines for children, including both the polio vaccine and the measles, mumps, and rubella (MMR) vaccine, public confidence in vaccine safety is somewhat lower for vaccines the federal government has recently shifted from routine recommendations to shared clinical decision-making for children.

Large majorities of adults say they are confident that polio vaccines (82%) and MMR vaccines (81%) are safe for children, including about half who say they are “very confident” (50% and 48% respectively). Both the MMR and polio vaccines continue to be recommended for routine immunization for all children.

While most adults are at least “somewhat confident” in the safety of hepatitis B (70%) and flu vaccines (65%) for children, smaller shares report being “very confident” (37% and 33% respectively). Confidence is lowest for the COVID-19 vaccine, with fewer than half of adults (48%) saying they are confident the COVID-19 vaccine is safe for children, including just one in four who are very confident. Three in ten adults say they are “not at all confident” in the safety of the COVID-19 vaccine for children, more than twice the share for any of the other vaccine asked about in this poll. These three vaccines were moved off the routine recommendation list to shared clinical decision-making, meaning vaccination is now determined through provider-patient discussions rather than recommended for all children.

Stacked bar chart showing percent who say they are very confident, somewhat confident, not very confident, or not at all confident that specific vaccines are safe for children.

Confidence in long-standing childhood vaccines like MMR and polio is bipartisan, with at least eight in ten across parties saying they are confident these vaccines are safe for children. While at least half across partisans express confidence in the safety of hepatitis B and flu vaccines for children, views are more partisan for these two vaccines that have recently been the subject of changing recommendations from federal health authorities. More than eight in ten (85%) Democrats say they are confident that the hepatitis B vaccine is safe for children, compared with smaller shares of independents (69%) and Republicans (61%). The poll finds a similar pattern for flu vaccines, with about eight in ten Democrats expressing confidence, larger than the share of independents (67%) or Republicans (52%) who say the same.

The partisan divide is widest for the COVID-19 vaccine. About eight in ten Democrats say they are confident in the safety of COVID-19 vaccines for children, nearly three times the share of Republicans who say the same (79% vs. 28%). About four in ten (45%) independents say they are confident in the safety of this vaccine for children. Partisanship has played a significant role in views of the COVID-19 vaccine since it was first available to the U.S. public in 2021.

MAHA supporters are among the groups least confident in the safety of the COVID-19 vaccine for children (31%). However, a majority of MAHA supporters are confident in the safety of the polio vaccines (78%) and MMR vaccines (77%), and to a lesser extent heptatitis B (60%) and the flu vaccine (55%).

Like the public overall, larger shares of parents express confidence in the safety of polio (77%) vaccines, MMR (76%), and to a lesser extent hepatitis B (70%) vaccines for children, compared to the flu (57%) or COVID-19 (31%) vaccines. This is consistent with poll findings from a KFF/Washington Post Survey of Parents, conducted last summer, which showed that trust in the flu and COVID-19 vaccines’ safety for children was divided along partisan lines, while at least eight in ten parents across partisanship were confident in the safety of polio and MMR vaccines.

Split bar chart showing percent who say they are very or somewhat confident that specific vaccines are safe for children. Results shown by total adults, total parents, party identification, and support for the Make America Healthy Again movement.

 

  1. With the changes to the vaccine schedule, the measles, mumps, rubella (MMR) vaccine and the polio vaccine remain routinely recommended for all children, while the flu and COVID-19 vaccines have been moved to shared clinical decision-making (SCDM). The hepatitis B vaccine is also no longer being recommended as routine, and instead only for certain high-risk groups and SCDM for others. See the new federally recommended childhood immunization schedule here: https://www.hhs.gov/childhood-immunization-schedule/index.html and KFF analysis of the changes here: https://www.kff.org/other-health/the-new-federal-vaccine-schedule-what-changed/ ↩︎

Methodology

This KFF Tracking Poll on Health Information and Trust was designed and analyzed by public opinion researchers at KFF. The survey was conducted January 13-20, 2026, online and by telephone among a nationally representative sample of 1,426 U.S. adults in English (n=1,355) and in Spanish (n=71). The sample includes 1,028 adults (n=60 in Spanish) reached through the SSRS Opinion Panel either online (n= 1,003) or over the phone (n=25). The SSRS Opinion Panel is a nationally representative probability-based panel where panel members are recruited randomly in one of two ways: (a) Through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Groups (MSG) through the U.S. Postal Service’s Computerized Delivery Sequence (CDS); (b) from a dual-frame random digit dial (RDD) sample provided by MSG. For the online panel component, invitations were sent to panel members by email followed by up to three reminder emails. 

Another 398 (n=11 in Spanish) adults were reached through random digit dial telephone sample of prepaid cell phone numbers obtained through MSG. Phone numbers used for the prepaid cell phone component were randomly generated from a cell phone sampling frame with disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents. Stratification was based on incidence of the race/ethnicity groups within each frame. Among this prepaid cell phone component, 149 were interviewed by phone and 249 were invited to the web survey via short message service (SMS). 

Respondents in the prepaid cell phone sample who were interviewed by phone received a $15 incentive via a check received by mail or an electronic gift card incentive. Respondents in the prepaid cell phone sample reached via SMS received a $10 electronic gift card incentive. SSRS Opinion Panel respondents received a $5 electronic gift card incentive (some harder-to-reach groups received a $10 electronic gift card). In order to ensure data quality, cases were removed if they failed two or more quality checks: (1) attention check questions in the online version of the questionnaire, (2) had over 30% item non-response, or (3) had a length less than one quarter of the mean length by mode. Based on this criterion, 2 cases were removed. 

The combined cell phone and panel samples were weighted to match the sample’s demographics to the national U.S. adult population using data from the Census Bureau’s 2025 Current Population Survey (CPS), September 2023 Volunteering and Civic Life Supplement data from the CPS, and the 2025 KFF Benchmarking Survey with ABS and prepaid cell phone samples. The demographic variables included in weighting for the general population sample are gender, age, education, race/ethnicity, region, civic engagement, frequency of internet use and political party identification. The weights account for differences in the probability of selection for each sample type (prepaid cell phone and panel). This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure. 

The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available on request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research. 

GroupN (unweighted)M.O.S.E.
Total1,426± 3 percentage points
   
Party ID  
Democrats473± 6 percentage points
Independents483± 6 percentage points
Republicans367± 6 percentage points
MAGA Republicans/Republican-leaning independents352± 6 percentage points
   
MAHA supporters618± 5 percentage points
Parents or guardians of children under 18 living in their household436± 6 percentage points
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Potential Impacts of Trump Administration H-1B Visa Policies on the Health Care and Social Assistance Industries

Published: Feb 5, 2026

Introduction

Immigrants, including those on H-1B visas, make significant contributions to the U.S. health care workforce and help to increase its capacity. H-1B workers are foreign workers with temporary approval to work in the U.S. in jobs that require specialized skills or knowledge. The Trump administration has implemented policies that will likely reduce the supply of H-1B workers, including a $100,000 entry fee for new H-1B visas as well as enhanced vetting and “online presence” reviews for all H-1B and H-4 (dependent) visa applications that have led to significant delays in visa processing.

This issue brief provides an overview of the H-1B visa program, analyzes trends in H-1B visa approvals for the health care and social assistance industries using data from the U.S. Citizenship and Immigration Services (USCIS) H-1B Employer Data Hub for fiscal years (FY) 2022-2025, and discusses potential implications of recent policies impacting the H-1B program on the U.S. health care workforce.

The analysis shows that H-1B workers have comprised an increasing role in the health care and social assistance industries in recent years with new and continuing H-1B visa approvals for the health care and social assistance industries rising by 8% between FY 2022 and 2025. As such, reductions in the H-1B workforce would likely lead to gaps in the industries and exacerbate existing health care worker shortages, including in the rural physician workforce.

Background

The H-1B visa program helps supply high-skilled workers to the U.S. workforce, including the U.S. physician workforce, particularly in lower income areas as well as within research universities and university-affiliated medical centers. The H-1B program allows U.S. employers to temporarily employ foreign workers for jobs that require specialized skills or knowledge. According to the American Hospital Association, physicians account for almost half of approved H-1B visas for medical and health occupations. Research further finds counties with the highest poverty levels had a higher percentage of H-1B-sponsored physicians and other health care workers compared to those with the lowest poverty levels (2.0% vs. 0.5%) and that rural counties similarly had a higher share of H-1B physicians and other health care workers than urban counties (1.6% vs. 1.0%). Research universities and university-affiliated medical centers are some of the largest employers of H-1B health care and social assistance workers. In FY 2025, the top three employers of workers with H-1B health care and social assistance visa approvals included Cleveland Clinic in Ohio, St. Jude Children’s Research Hospital in Tennessee, and Memorial Sloan Kettering Cancer Center in New York.

The number of new H-1B visas is capped at 65,000 each year with an additional 20,000 visas for those with a U.S. master’s degree or higher, although the cap is typically exceeded via exemptions. The H-1B visa cap of 65,000 was first established in 1990 under the Immigration Act of 1990, although it was temporarily increased from FY 1990-2000 as well as FY 2001-2003 by Congress. In FY 2004, the cap reverted to 65,000, with an additional 20,000 new visas reserved for those with a U.S. master’s degree or higher and has stayed the same since. However, the number of new H-1B visas granted each year generally exceeds the annual cap of 85,000 because of cap exemptions. For example, institutions of higher education, government research organizations, and certain nonprofits are exempt from the annual cap.

The Trump administration has implemented changes that are expected to reduce the number of H-1B workers in the U.S. These changes include a Proclamation issued on September 19, 2025, under which new H-1B visa petitions by employers must be accompanied by a $100,000 entry fee, a move that is being legally challenged by 20 states on the basis that it violates the Administrative Procedure Act. The Department of Labor launched Project Firewall in September 2025, which has led to an increase in random site visits and stricter scrutiny of third-party worksites in an effort to root out H-1B “fraud and abuse.” Additionally, the U.S. Department of State began enhanced vetting and “online presence” reviews of all H-1B and H-4 (dependent) visa applications starting December 15, 2025, which has led to significant delays and cancellations of visa interviews, leading to many H-1B workers getting stuck abroad.

Based on KFF analysis of data from USCIS, new and continuing H-1B visas for the health care and social assistance industries increased by over 8% from just under 18,000 in FY 2022 to over 19,000 in FY 2025 (Figure 1). The Bureau of Labor Statistics defines the health care and social assistance industries as establishments that provide health and medical care, as well as those that provide social assistance. Examples of such establishments include but are not limited to hospitals, clinics, nursing homes, medical laboratories, home health agencies, and social service centers. In contrast, the total number of new and continuing H-1B visas across other industries fell by 9% from over 420,000 in FY 2022 to about 390,000 in FY 2025.

USCIS Has Approved an Increasing Number of H-1B Visas for the Health Care and Social Assistance Industries (Stacked column chart)

H-1B workers play a particularly significant role in the health care and social assistance industries in certain states. NY (14%), MA (9%), CA (8%), PA (6%), and OH, TN, and FL (5% each) accounted for over half (52%) of new and continuing H1-B visas for the health care and social assistance industries approved in FY 2025 (Figure 2). These states are home to large research universities and medical centers, which, as noted, are some of the biggest employers of H-1B workers in the health care and social assistance industries.

Seven States Accounted for Over Half of All Approved H-1B Visas in the Health Care and Social Assistance Industries in FY 2025 (Pie Chart)

Implications

These data suggest that H-1B workers have played an increasingly large role in the health care and social assistance industries in recent years, suggesting that reductions in the supply of H-1B workers could leave gaps that exacerbate health care worker shortages. Recent actions by the Trump administration are anticipated to reduce the number of H-1B workers in the U.S., including the new $100,000 entry fee as well as “online presence” reviews for H-1B visa applications. A decline in the supply of H-1B workers in the health care and social assistance industries could disproportionately impact states that employ the largest numbers of H-1B workers, lower income and rural areas where H-1B health care workers often are employed, and smaller employers who would face greater challenges paying the new $100,000 fee. Research universities and university-affiliated medical centers, which are some of the largest employers of H-1B health care workers, also are likely to be disproportionately impacted at a time when they are already facing broader funding cuts. The resulting shortages in the health care workforce are likely to increase barriers to accessing health care, potentially affecting the health and well-being of the population over the long term.

These actions to reduce the number of H-1B workers come against a backdrop of increased immigration enforcement as well as other restrictions on lawful immigration into the U.S. These efforts have reduced the flow of immigrants into the country and have increased fears among immigrants already here. Researchers project that restrictive policies undertaken by the Trump administration could reduce legal immigration into the U.S. by 33% to 50% over four years as compared to FY 2023 levels. Broad reductions in immigrants could particularly affect the health care workforce given the significant role they play as hospital physicians, nurses, as well as direct long-term care workers. These reductions may be compounded by a projected decline in the U.S.-born labor force over the next few decades due to an increase in the share of the U.S.-born population that is over 65 years of age and therefore less likely to participate in the workforce.

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ACA Marketplace Enrollment is Down in 2026—But All of the Data Isn’t in Yet

Published: Feb 5, 2026

2026 marks the first year since 2020 that enrollees in the Affordable Care Act Marketplaces do not have access to enhanced premium tax credits. The effect of the expiration on how many people will use ACA Marketplace coverage remains unclear.

New data released by CMS on plan selections show that ACA sign-ups for 2026 are down by over 1 million people compared to the same time last year, marking the first year since 2020 that sign-ups appear to have declined. A more detailed Health Insurance Exchanges Open Enrollment Report is expected in March or April that will detail demographics, income, and metal levels for people who select or are automatically renewed into a plan. Plan selection data is unable to fully capture the effects of the enhanced tax credits expiring on the number of people with coverage. As some people end up not making their premium payments, actual enrollment—known as “effectuated” enrollment—will inevitably decline. With the expiration of enhanced premium tax credits, premium payments are estimated to have increased 114%, on average, for subsidized enrollees who stay in the same plan. With such steep increases, it is not yet clear how many people who have selected a plan during Open Enrollment will make a payment. 

This brief explains the limitations of early data in understanding the impact of the expiration of enhanced premiums tax credit on ACA enrollment. It also provides a timeline of when more complete data will become available. The bottom line is that it will be quite a while before we get a complete picture of how much enrollment has dropped following expiration of the enhanced premium tax credits.

What are the limitations of plan selection data?

Plan selection (or “sign-up”) data does not accurately reflect the number of people who ultimately have ACA Marketplace coverage because it does not account for premium payments. In other words, it shows how many people have selected a plan or been automatically renewed into ACA coverage, but it does not show how many people actually gain or maintain coverage.

New enrollees are generally required to submit their first premium payment (“binder” payment) within 30 days of the coverage effective date, thus “effectuating,” or beginning, their coverage. Returning subsidized customers, however, are generally given a 3-month grace period for nonpayment of premiums. This means that these returning consumers would then have until March 31, 2026, to catch up on premium payments before their coverage is retroactively terminated. The impact of enhanced subsidies expiring will therefore not be evident (even to insurers) until all applicable grace periods have been exhausted.

For 2026, nearly 20 million of the plan selections are returning customers. Plan selection data from 2025 shows that more than four in ten people in the ACA Marketplaces were automatically renewed into their coverage that year, meaning they did not actively sign up for their plan. As consumers automatically renewed for 2026 received their first premium bills for January, some may have disenrolled or stopped making a payment. Depending on what action they take and the timing, many people could be counted in preliminary plan selection data (in the “Final Snapshot” just released and the “Open Enrollment Report” in the spring) even though they may not truly have coverage.

When will we know more about ACA enrollment?

Below is a timeline of key ACA Marketplace deadlines and data releases. The data timing listed below is based on recent years’ release dates and there could be different dates in 2026. The section following the timeline explains each of these data sources in detail.

TimingDeadline or Data Release
January 15, 2026End of Open Enrollment in most states
January 28, 2026Final Marketplace Open Enrollment Period Report: National Snapshot (plan selections) in most states; preliminary data are included for states with later open enrollment periods
January 30, 2026Last possible payment due date for January 1 enrollments in new plans
January 31, 2026End of Open Enrollment in all states
March 2, 2026Last possible payment due date for February 1 enrollments
March 31, 2026Payment grace period ends for automatic renewals processed December 15
March/April 2026*CMS Health Insurance Exchange Open Enrollment Report and Public Use Files (plan selections)
April/May 2026Public insurer first quarter earnings reports
May/June 2026Earliest 2027 insurer rate filings to state regulators become public
July 2026*Effectuated Enrollment: Early 2026 Snapshot
January 2027*Biannual National Health Interview Survey (NHIS) Early Release Data
July 2027*Effectuated Enrollment: Full Year 2026—accounts for grace period retroactive terminations
July 2027*Finalized HHS Risk Adjustment Program State-Specific Data; additional rate filings
July 2027*Issuer Level Enrollment Public Use File
2028*Enrollee-Level External Data Gathering Environment (EDGE) data

*Note: Timing is based on recent years and may change for plan year 2026.

Effectuated Enrollment

The effectuation rate is the share of people who have a plan selection during Open Enrollment who effectuate (or start) their coverage. While it is possible that some states or insurers may provide information about effectuation rates earlier, the first national data on ACA enrollments will likely come out in July 2026 with the Effectuated Enrollment Report, if the timing of past years is followed.

As shown in the chart below, the effectuation (or premium payment) rate has been quite high since 2022, meaning the vast majority of consumers who selected a plan ended up with coverage. For that reason, in recent years, plan selections and effectuated enrollment have often been discussed synonymously. However, the expiration of enhanced premium tax credits in 2026 will mark the first time that most ACA Marketplace enrollees experience a significant increase in their premium payments, making past years’ effectuation rates unreliable indicators of this year’s rate.

CMS typically releases an Effectuated Enrollment: Early Snapshot each summer. This data will provide a better picture of the impact of the expiration of enhanced tax credits on enrollment than plan selection data alone.

Based on past years, the Effectuated Enrollment: Early Snapshot report will likely be released in July 2026, and will report February 2026 effectuated enrollment, as measured on March 15, 2026. In other words, the July data release will likely show how many people had effectuated enrollment in February, based on what insurers know about premium payments by mid-March. However, as mentioned above, returning customers have until the end of March to make premium payments under the grace period. So even the data released in July of 2026 may still overstate the number of enrollees.

The effectuated enrollment data released in July of 2026 will likely not count new consumers who missed their binder payment for January or February, nor would it count consumers who were automatically renewed in December but then actively disenrolled in January. However, it wouldstill count people who were automatically renewed for January coverage and did not make a payment during the grace period—even if they eventually had their coverage retroactively terminated as of January 31.

The Effectuated Enrollment: Full Year 2026 data, likely to be released in the summer of 2027, would show the number of effectuated enrollees after all grace periods have elapsed. As a share of plan selections made during Open Enrollment, the chart below shows the final February effectuation rate from the Full Year (green) data has historically been a few percentage points lower than the Early Snapshot (blue).

Fewer Consumers Maintain Coverage than Sign Up during Open Enrollment (Line chart)

Another reason the Effectuated Enrollment: Early Snapshot (expected to be released in July 2026) may not give a complete picture of the effect of expiring enhanced tax credits is that there could still be additional coverage loss later in the year. If an enrollee makes an initial premium payment but then decides their premium is unaffordable and drops their coverage mid-year, they may still be counted in the Effectuated Enrollment: Early Snapshot data even though they will not have coverage after their termination.

CMS may release additional effectuated enrollment counts before the Effectuated Enrollment: Full Year report; since this additional reporting may be after the run-out of grace periods, they would reflect finalized enrollment. In 2025, effectuated enrollment counts for the first five and seven months were released. Additionally, these releases may include information on the contribution of premium tax credits to the gross premium.

While effectuated enrollment data will tell us the number of people who are covered by ACA plans, it will not provide information about who paid their premium. The Open Enrollment Report and concurrent public use files, based on plan selections, will be the earliest source of information about income and other demographics of ACA enrollees. It is likely that the demographics and income distribution of ACA enrollees could shift from between the measurement of plan selections and effectuated enrollment. Additionally, the effectuated enrollment data from the Full Year report does not typically include metal level selection. There could be differences in payment rates for people who stay in their previous plan and face large premium increases and those who switch to lower-cost plans.

Quarterly Earnings Reports: April and May 2026

Prior to the publication of the effectuated enrollment data, some data on enrollment trends may be available from the insurers that enroll large shares of the individual market, during investor earnings calls. Insurers will host their fourth-quarter and year-end 2025 earnings calls in late January or February of 2026: Centene and Oscar will host their Q4 earnings calls on February 6 and February 10, respectively.

Insurers may start releasing membership counts for 2026 during their first-quarter 2026 earnings calls, expected to happen in April or May. Centene has announced their first-quarter earnings call for April 28. Elevance and UnitedHealthcare typically have first-quarter calls in April, while Oscar and Cigna typically report earnings in May. First-quarter calls that include enrollment information may not be fully adjusted for retroactive terminations due to nonpayment grace periods.

Insurer Rate Filings: Summer 2026

Every spring and summer, individual market insurers, including those offering ACA Marketplace plans, publicly file proposed premium rate changes to state regulators. These filings offer insight into what insurers believe is driving health cost growth and changes in enrollment. These rate filings will show insight into what insurers are planning in 2027 and may provide early counts of 2026 enrollment.

National Health Interview Survey Quarterly Releases: Likely January 2027

The National Health Interview Survey (NHIS) early release data will provide early indications of changes in the uninsured rate without the enhanced tax credits. From 2021-2024, first-quarter data came out in the summer of the same year, and data for the second quarter of the year came out closer to the end of the year. The Centers for Disease Control and Prevention has transitioned to biannual releases of data and released data for the first half of 2025 at the end of January 2026. If this release schedule remains consistent, data for the first half of 2026 may become available in early 2027.

Risk Adjustment Data: July 2027

Based on past years, the CMS Risk Adjustment Program State-Specific Data for 2026 is expected to come out in July 2027. The risk adjustment data will provide a state-by-state look at how many billable member months were reported for the ACA-compliant individual market. Because it will include on- and off-Marketplace enrollment, it will capture all people in ACA compliant coverage, even if they chose to purchase it off-exchange.

Issuer Level Enrollment Data: July 2027

The issuer-level enrollment data is split between HealthCare.gov and state-based exchanges. Data for HealthCare.gov states includes more information, including average monthly effectuated enrollment and average months of enrollment for those who have disenrolled. Additionally, issuer-level enrollment across all states will be made available through the Medical Loss Ratio Data and System Resources Public Use File, released late in the following year.

Enrollee-Level External Data Gathering Environment (EDGE): 2028

Enrollment by metal tier can be determined using the Enrollee-Level External Data Gathering Environment (EDGE) dataset, but this is subject to its own limitations: sparse enrollee demographic information, incomplete longitudinal data, and no information on terminated/non-effectuated coverage prevent fine-grained analysis on how the expiration of enhanced premium tax credits affected enrollee decisions. EDGE data for 2026 will likely not be available until 2028.

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Community Health Center Patients, Financing, and Services

Published: Feb 4, 2026

Community health centers are a national network of nearly 1,400 safety-net primary care providers that served more than 32 million patients in 2024. They are located in medically underserved urban and rural communities and provide comprehensive primary care services to patients regardless of their ability to pay, providing a range of medical, behavioral, and supportive services. This brief reports on health center patients, services, and financing in 2024 and analyzes changes over time using national data from the Uniform Data System (UDS), to which all health centers are required to report annually, though variation exists across states. An upcoming brief will focus on health center patients, services, and financing specifically among rural health centers.

Editorial Note: This brief was updated on February 11, 2026 to clarify what the data on reported usual source of care for immigrant adults represent.

Introduction

Key Takeaways

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  • Health centers served 32.4 million patients in 2024, an increase of over a million from 31.3 million patients in 2023. Nine in ten health center patients live in low-income households, over six in ten are patients of color, and three in ten live in rural areas.
  • About half of health center patients are covered by Medicaid while 22% have private insurance (including ACA Marketplace coverage) and 18% are uninsured. Despite an increase in the number of privately insured patients, the number of uninsured health center patients increased in 2024, likely due to the unwinding of the Medicaid continuous enrollment provision that led to a decline in the number of Medicaid patients, following several years in which the number of Medicaid patients increased.  
  • Medicaid was the largest revenue source for health centers, accounting for 45% of the $49.8 billion in total health center revenue in 2024. Health center revenue increased in 2024 due to growing patient volume and revenue from payers, but net margins that account for revenue and costs fell from 1.6% in 2023 to -2.1% in 2024.
  • Of the more than 139 million patient visits in 2024, 65% were for medical services, 14% were for mental health and substance use disorder (SUD) services, and 12% were for dental care. The share of health center visits conducted via telehealth remained steady from 2023, with 17.7 million telehealth visits (13%) in 2024.
  • Amid significant federal policy changes and funding uncertainty, health centers face a number of challenges. Changes to Medicaid and the ACA Marketplace included in the 2025 reconciliation law and the expiration of ACA Marketplace enhanced premium tax credits at the end of 2025 are likely to increase the number of uninsured patients and patients who cannot afford out-of-pocket costs, placing new financial burdens on health centers. In addition, increased immigration enforcement in health care settings along with proposed changes to federal immigration policies may sow confusion and fear of using health center services among immigrant patients. At the same time, health centers face ongoing financial uncertainty amid federal funding stand-offs in Congress. The 2026 Consolidated Appropriations Act increases slightly health center funding to $4.6 billion for fiscal year 2026, but only extends funding through December 2026, including for the Community Health Center Fund, which was designed to provide more stable, longer-term funding.

Health Center Patients

Health Center Organizations

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In 2024, 1,359 health center organizations provided care at over 16,300 service delivery sites (Figure 1). Roughly six in ten health centers served patients in medically underserved urban areas, while four in ten served rural communities. Seven in ten (71%) health centers provided care to 25,000 or fewer patients while 3% of health centers served 100,000 or more patients in 2024. Generally, smaller health centers are located in rural areas or focus services on certain neighborhoods or populations, while larger health centers tend to serve more urban areas and operate multiple clinic locations. In addition to traditional locations, health center sites include those located at schools, homeless shelters, and mobile sites, and some sites may operate seasonally.

The Number of Health Center Organizations by Total Patients Served, 2024 (Donut Chart)

Patient Demographics

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The number of patients served by health centers increased by over a million from 31.3 million in 2023 to 32.4 million in 2024, with increases across all age groups (Figure 2). Health centers served 9.4 million children in 2024, representing 29% of health center patients. Adults ages 18-64 comprised 59% of health center patients while adults ages 65+ made up 12%. The number of children served by health centers dropped during the pandemic and has been slow to rebound. Although still a small share of the total patient population, the number of adult patients ages 65+ served at health centers grew by 38%, or over one million, from 2019-2024, compared to 2% among children and 7% among adults ages 18-64 in the same period.

Health Center Patients by Age Group, 2019-2024 (Stacked column chart)

A majority of health center patients live in low-income households (Figure 3). Reflecting the mission of health centers to serve anyone regardless of ability to pay, nine in ten (90%) patients served at health centers had incomes that were at or below 200% of the federal poverty level (FPL) and two-thirds of patients (67%) had incomes at or below the poverty level in 2024 (the poverty level was $31,200 for a family of four in 2024). The share of low-income patients served at health centers is over three times that of the U.S. population, in which 27% of individuals lived in households earned under 200% FPL in 2024.

Health Center Patients by Income Status, 2024 (Pie Chart)

Most health center patients (64%) are people of color, greater than their share of the total U.S. population in 2024 (Figure 4). Across all health centers, Hispanic patients comprised the largest share of patients at 40%, followed by White patients (36%), Black patients (17%), Asian patients (4%), and all other patients (3%).

Race and Ethnicity of Health Center Patients, 2024 (Stacked column chart)

Special Patient Populations

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Health centers served millions of patients who were part of special populations with distinct health needs in 2024 (Figure 5). The Health Resources and Services Administration (HRSA), which administers the health center program, provides targeted funding for health centers that serve certain populations identified as underserved by the federal government, including people experiencing homelessness and migratory agricultural workers. In 2024, health centers served 1.5 million patients experiencing homelessness (5% of all patients), 1.2 million patients in school-based health centers (4% of all patients), 1.1 million agricultural workers (3% of all patients), and 400k patients who were veterans (1% of all patients). In addition, health centers are also required to report data on other populations with known challenges accessing primary care. For example, three in ten patients (30% or 9.9 million) were rural residents, which is higher than the 20% of the U.S. population living in rural areas, and nearly three in ten patients (28% or 9 million) are best served in a language other than English.

Health Center Patients by Selected Special Populations, 2024 (Bar Chart)

Health Coverage of Health Center Patients

Overall Health Coverage

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Over eight in ten (82%) health center patients had health insurance coverage in 2024 (Figure 6). Nearly half (49%) of health center patients were covered by Medicaid while 22% of patients had private insurance (including ACA Marketplace coverage), 7% were covered by Medicare, and 4% were dual-eligible patients who had both Medicare and Medicaid coverage. Medicare is likely the primary payer for health center services among dual-eligible patients, but Medicaid may cover the costs for dental services and some mental health or substance use disorder services. Nearly one in five (18%) health center patients were uninsured. The share of health center patients who were uninsured varied widely by state, ranging from 9% in several states to as high as 43% in Utah. This variation likely reflects a mix of factors such as the types of health centers in the state, characteristics of the health center patient populations, and state Medicaid expansion status.

Change in Uninsured Patients

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After several years of decline, the number of health center patients who were uninsured increased in 2024. From 2023 to 2024, the number of uninsured health center patients increased by over 250,000 from 5.6 million to nearly 5.9 million (Figure 6). At the same time, the number of privately insured patients increased by over 11% (716,000) while the number of Medicaid patients dropped by 43,000 or less than 1% from 2023. The drop in Medicaid patients in 2024 after several years of increases is likely attributable to the end of the Medicaid continuous enrollment provision, which temporarily halted Medicaid disenrollments from March 2020 through March 2023. Starting in April 2023, states resumed disenrollments as part of the unwinding of continuous enrollment in Medicaid, and national Medicaid/CHIP enrollment has since declined. Enhanced premium tax credits for Marketplace coverage, adopted in 2021 and extended through December 2025, drove a record increase in Marketplace enrollment that likely led to the increase in health center patients with private insurance.

Health Coverage Among Health Center Patients, 2019-2024 (Stacked column chart)

Medicaid Coverage of Health Center Patients by State

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While Medicaid is an important source of coverage for health center patients, the share of child and adult health center patients covered by Medicaid varied widely by state (Figure 7). Nationwide, about 6.9 million (74%) child health center patients ages 0-17 and 10.3 million (45%) adult health center patients ages 18 and older were covered by Medicaid and CHIP, including dual-eligible health center patients who had both Medicare and Medicaid coverage. The share of child health center patients covered by Medicaid ranged from less than 50% in two states to 80% or more in nine states and DC, while the share of adult health center patients covered by Medicaid was less than 20% in six states and more than half in eight states and DC.

Percent of Child Health Center Patients Covered by Medicaid by State, 2024 (Choropleth map)

Health Center Financing and Costs

Health Center Revenue

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Despite the expiration of most COVID-19 funding and other supplemental funding provided during the pandemic, health center revenues continued to increase in 2024 due to growing patient volume and revenue from payers. In 2024, total health center revenue was $49.6 billion, an increase of 6% from $46.7 billion in 2023 (Figure 8). Nearly three quarters (73%) of health center revenue came from payments from Medicaid, private insurance, Medicare and self-pay patients, with Medicaid accounting for over 60% of patient care revenue and 45% of total revenue. Federal Section 330 grant funding, which supports health centers’ role as safety net providers, made up 11% and other grants and contracts were 15% of total revenue. COVID-19 funding largely expired after 2023 and accounted for just 1% of total revenue in 2024. From 2019 to 2024, patient care revenue increased as a share of total revenue from 68% to 73%. At the same time, Federal Section 330 grants decreased as a share of total revenue from 16% in 2019 to 11% in 2024.

Health Center Revenue by Payer Source, 2019 - 2024 (Stacked column chart)

Per Patient Revenue

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Federal Section 330 funding per uninsured patient is lower than per patient revenue from other payers (Figure 9). Federal section 330 grants support ongoing care to the uninsured, although section 330 grants are not tied directly to the number of uninsured patients health centers serve and may vary widely between health centers. In 2024, federal section 330 funding per uninsured patient ($906) was lower than per patient revenue from Medicare ($1,528), Medicaid ($1,418), and private insurance ($951). Section 330 funding per uninsured patient increased 26% from 2019 to 2023 but dropped 3% from 2023 to 2024 as the number of uninsured patients increased. From 2019 to 2024, growth in Section 330 funding per uninsured patient was lower than the growth in per patient revenue from Medicare (68%), Medicaid (47%), and private insurance (45%) during the same time period.  

Health Center Revenue per Patient by Coverage, 2019-2024 (Line chart)

Health Center Costs

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Rising operating costs outstripped increases in revenues in 2024, causing the national health center net margins to fall to -2.1% (Figure 10). Net margins account for both costs and revenue and are reported as a percentage of revenue. The strong positive net margins from 2020 through 2022 were driven primarily by the increase in COVID-related and other supplemental funding during the pandemic. The negative net margin in 2024 reflects higher costs, which increased 62% from 2019-2024 due to inflation, as well as reduced revenue from the expiration of COVID-19 funding. Net margins will vary by health center depending on factors such as their share of uninsured patients, operating costs, the amount of competitive federal grant funding they are awarded, and other sources of revenue.

Health Center Net Margins, 2019-2024 (Column Chart)

Health Center Services and Workforce

Health Center Visits

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Health centers provided more than 139 million visits in 2024 (Figure 11). Most visits (65%) were for medical services, though health centers also provided a wide range of other clinical and supportive services, including mental health and substance use disorder (SUD) services (14%), dental services (12%), vision services (1%), and other professional services (3%), which include services such as nutrition counseling, physical therapy, and traditional healing. Enabling or supportive services, which are non-clinical services like case management, transportation, and health education that facilitate access to care, represented 5% of all visits. Health centers are required by federal law to provide primary care and supportive services, and they may offer dental, vision, or other services depending on patient need and organizational capacity.

Health Center Visits by Service Type, 2024 (Donut Chart)

Telehealth

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The share of health center visits conducted via telehealth remained steady from 2023 after several years of decline. In 2024, health centers provided 17.7 million telehealth visits, which represented 13% of all visits (Figure 12). The number of telehealth visits peaked in 2020 at the start of the coronavirus pandemic when 28.5 million visits (25%) were conducted via telehealth but declined from 2021 through 2023 before increasing slightly in 2024. Telehealth represents an important way for patients to access health center services, particularly since some patients face geographic and transportation barriers that can make it more difficult for them to attend in-person visits.

Telehealth and In-Person Visits to Health Centers, 2019-2024 (Stacked column chart)

Health Center Workforce

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Health centers employed over 313,000 full-time equivalents (FTE) in 2024 (Figure 13). Most (61%) health center staff provide patient care or enabling services, including medical (33%), enabling (10%), dental and vision (7%), mental health and substance use disorder (7%), pharmacy (3%), and other professional services (1%). The remaining 39% of health center staff work in facility and non-clinical support. Health centers are important employers in their communities; however, they consistently report workforce shortages as one of their main challenges. Research indicates those shortages have worsened over time. Ongoing funding challenges and delays may further exacerbate these challenges.

Health Center Workforce by Category, 2024 (Donut Chart)

Impact of Federal Policy Changes

Medicaid and Marketplace Changes in the 2025 Reconciliation Law

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Changes to Medicaid and the ACA Marketplace included in the 2025 reconciliation law are estimated to increase the number of people without health insurance in 2034 by 10 million, which may have an outsized impact on the health center patient population. These coverage losses will be driven primarily by new Medicaid policies like mandatory work requirements for the ACA adult expansion population and the requirement for states to conduct eligibility redeterminations every six months rather than annually, and Marketplace changes, including the elimination of auto renewal and the special enrollment period for people with income less than 150% FPL. These changes are likely to lead to some health center patients losing coverage, even as many health centers provide assistance to patients to help them navigate the new Medicaid and Marketplace rules. Furthermore, changes to Medicaid financing, such as limits on states’ ability to use provider taxes and caps on federal funding for state directed payments to managed care organizations, reduce the federal share of funding, and limit state flexibility in setting provider rates and expanding coverage given ongoing state budget challenges.

Health centers are a primary source of care for immigrant adults, but the 2025 reconciliation law includes eligibility restrictions and make many lawfully present immigrants ineligible for Medicaid and CHIP, ACA Marketplace subsidies, and Medicare. While health centers do not publicly report patient immigration status, data from the 2025 KFF/New York Times Survey of Immigrants show that three in ten (30%) immigrant adults say a health center is their usual source of care, with this share rising to nearly half (45%) of likely undocumented immigrant adults and nearly four in ten (37%) among immigrant adults with limited English proficiency. These data reflect shares of immigrant adults who report they use a health center when they are sick or need health advice but do not reflect use of care over any specified time period and cannot be used to estimate the share of health center patients who are immigrants in a given year. The law limits eligibility for Medicaid and CHIP, subsidized Marketplace coverage, and Medicare, eliminating coverage for many groups of lawfully present immigrants, including refugees, asylees, and people with Temporary Protected Status, among others. Some states have also reduced or eliminated state-funded coverage designed to fill gaps in federally funded coverage for immigrants due to funding challenges, further reducing coverage options for immigrant health center patients. Reliance on health centers may increase among immigrants who become uninsured as their affordable health care provider options become more limited.

The 2025 reconciliation law also stripped federal Medicaid funding for one year to Planned Parenthood clinics, which may increase demand for family planning services at health centers. This follows actions by the Trump Administration and a Supreme Court ruling that restricted funding to some providers of reproductive and sexual health care services. The share of female Medicaid enrollees who received their last contraceptive visit at a health center across the U.S. was 18% in 2023, with wide variation across states. Health centers may face difficulties in ramping up the availability of family planning services to meet the higher demand if other clinics close.

Expiration of the Enhanced Marketplace Tax Credits

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The expiration of ACA Marketplace enhanced premium tax credits at the end of 2025 has increased premium payments for many enrollees and will likely increase the number of uninsured health center patients. Because the enhanced subsidies were allowed to expire at the end of 2025, premium payments for enrollees receiving subsidies increased by 114% on average. While some Marketplace enrollees likely shifted to lower cost plans in response to the reduction in financial assistance, some have been forced to drop coverage. High marketplace enrollment helped keep the uninsured rate low in 2024, but expiration of the enhanced tax credits may reverse recent increases in the number of health center patients with private coverage. Additionally, the shift to lower-cost bronze plans by health center patients could lead to more uncompensated care costs for health centers if patients are unable to afford the higher out-of-pocket costs.

Trump Administration Immigration Policies and Enforcement Actions

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New federal policies could require health centers to verify patient immigration status. The U.S. Department of Health and Human Services (HHS) issued a notice of a policy change to update the definition of “federal public benefits” as outlined in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) to add the Health Center Program, among others, to a list of programs considered “federal public benefits” that are restricted to individuals with a “qualified” immigration status. The policy change bars many lawfully present and undocumented immigrants from accessing care at health centers. However, while the notice limits the health center program to “qualified immigrants,” it does not change the underlying statutory requirements for health centers to serve patients regardless of immigration status, and it remains to be seen how enforcement of the guidance will affect health centers’ ability to provide care. The policy faces legal challenges and in September 2025, a court blocked implementation of the policy as it relates to the Health Center Program in 20 states and DC.

Changes in public benefit policies along with increased federal immigration enforcement actions may have a chilling effect on enrollment in health coverage and access to care among a broad group of immigrant families utilizing health center services, including citizen children in those families. Data from the KFF/New York Times 2025 Survey of Immigrants show that about one in ten immigrant adults say they stopped participating or avoided applying for an assistance program that helps pay for food, housing, or health care because they didn’t want to draw attention to their or a family member’s immigration status. Increased immigration enforcement in health care settings, federal data sharing used for immigration enforcement, proposed changes to federal public charge policy and policies requiring health centers to check immigration status can have negative impacts on the health and well-being of immigrant families due to more limited access to services as well as confusion and fear about using health center services.

Financial Challenges

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Health coverage changes in the 2025 reconciliation law and expiration of the ACA enhanced premium tax credits will likely increase financial pressures for health centers. Research has estimated that health centers could experience over $3 billion in revenue reductions from a drop in the number of patients covered by Medicaid and an increase in the number of uninsured patients resulting from the 2025 reconciliation law’s health provisions. While many provisions in the new law, including some of the largest sources of federal Medicaid savings such as work requirements and financing changes, do not take effect until 2027 or later, other policy changes, such as changes to immigrant eligibility for Medicaid and Marketplace coverage and expiration of ACA enhanced premium tax credits, can impact health center finances earlier. An increase in uncompensated care costs would exacerbate financial challenges at health centers, which experienced negative net margins nationwide in 2024 amid rising operating costs.

Federal funding delays contribute to financial uncertainty for health centers. While Congress previously insulated health centers from funding lapses by authorizing the Community Health Center Fund for five years, the most recent two-year authorization was temporarily extended from September 30, 2025 to January 30, 2026 as part of the continuing resolution that reopened the federal government after a 43-day shutdown. On February 3, 2026, Congress passed the 2026 Consolidated Appropriations Act, which slightly increases health center funding to $4.6 billion for fiscal year 2026, but only extends funding through December 2026. The funding delays create significant challenges for health centers, which rely on federal funding to maintain operations and provide care to uninsured patients. Funding gaps earlier in 2025 caused health center closures, and the funding lapse due to the government shutdown led several states to allocate additional funds for health centers.

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FY 2026 National Security, Department of State and Related Programs (NSRP) Global Health Funding in the Consolidated Appropriations Act

Published: Feb 4, 2026

Update: On February 3, 2026, the President signed the “Consolidated Appropriations Act, 2026” which includes funding provided in the FY 2026 National Security, Department of State and Related Programs (NSRP) appropriations bill and accompanying explanatory statement detailed below. This resource was originally published on January 14, 2026.

On January 11, 2026, the Appropriations Committee released the FY 2026 National Security, Department of State and Related Programs (NSRP) (formerly State, Foreign Operations, and Related Programs [SFOPs]) appropriations bill and accompanying explanatory statement. The bill and explanatory statement include funding for U.S. global health programs at the State Department. Funding for global health programs at the State Department through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totals $9.4 billion, which is a decrease of $615 million (-6%) compared to the FY25 level ($10 billion). All program areas either decreased or remained flat as follows:

  • Decreased: Funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), bilateral HIV, tuberculosis (TB), global health security, neglected tropical diseases (NTDs), and vulnerable children declined; while the Global Fund accounted for the largest decrease (-$400 million or -24%), this funding supports the administration’s pledge of $4.6 billion for the eighth replenishment and serves as the first installment of that pledge. In addition, the explanatory statement accompanying the bill states that there are also “sufficient unobligated balances” from prior Acts “to fulfill the United States pledge for the seventh replenishment.”
  • Remained Flat: Funding for malaria, maternal and child health (MCH), nutrition, and family planning and reproductive health (FP/RH) remained flat.

In addition, the bill included provisions that either impact or provide direction on global health funding including:

  • Program Area Amounts: Funding for many of the global health program areas is specified in the explanatory statement (rather than the bill). Unlike prior years, this bill specifically states that funding “shall be made available at not less than the amounts specifically designated in the respective tables included in the explanatory statement” ensuring that the administration is required to provide the amounts for the areas specified. The bill also prohibits the administration from deviating from the global health amounts in the bill and explanatory statement.
  • Funding Availability Timeframe: PEPFAR funding (bilateral HIV and the contribution to the Global Fund) is available for five years. Funding for most other program areas is provided for two years, with the exception of funding for Gavi, the Vaccine Alliance and the Coalition for Epidemic Preparedness Innovations (CEPI), which is provided for one year.
  • Reports/Briefings: The bill requires the administration to provide updates (via reports or briefings) on numerous global health areas including (but not limited to) the PEPFAR Transition Strategy, Market Access Strategy, bilateral health agreements, multilateral health engagement, the development of an Innovation Fund, and the status of available funding (i.e. apportionment, allocations, obligations, and disbursements).
  • Additional Requirements: The bill requires coordination with the Centers for Disease Control and Prevention (CDC) on global health activities and establishes the Prevention, Treatment, and Response Initiative, which supports “research, development, and delivery of vaccines and other prevention technologies”.

See the table below for additional detail on global health funding. See other budget summaries (including the summary on FY 2026 Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) global health funding) and the KFF budget tracker for details on historical annual appropriations for global health programs.

KFF Analysis of Global Health Funding in the FY 2026 Conference Appropriations Bill & Explanatory Statement (Table)
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FY 2026 Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) Global Health Funding in the Consolidated Appropriations Act

Published: Feb 4, 2026

Update: On February 3, 2026, the President signed the “Consolidated Appropriations Act, 2026” which includes funding provided in the FY 2026 Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) conference bill and accompanying report detailed below. This resource was originally published on January 22, 2026.

The Committee on Appropriations released its FY 2026 Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) conference bill and accompanying report on January 20, 2026.

While most U.S. global health funding is provided to the State Department through a separate appropriations bill (see the KFF budget summary on this funding here), the Labor HHS appropriations bill includes funding for global health programs at the Centers for Disease Control and Prevention (CDC) as well as funding for global health research activities at the National Institutes of Health (NIH). Total global health funding at CDC and NIH through the Labor HHS bill is not yet known, as funding for some programs (i.e. global HIV/AIDS and malaria research) at NIH is determined at the agency level rather than specified by Congress in annual appropriations bills. Funding for global health in the Labor HHS bill remained flat compared to the FY 20251 level as follows:

  • CDC: Funding for global health programs at CDC totals $693 million, the same level as the FY 2025 enacted amount.2 Within CDC, funding for each specific global health program area was also maintained at the FY 2025 level.
  • NIH: Funding for global health research activities at the Fogarty International Center (FIC) at NIH totals $95 million, the same level as the FY 2025 enacted amount.

In addition, Section 236 under the Labor HHS section of the bill specifically states that funding “shall be for the budget activities, and in the amounts specified in the table under each such heading in the explanatory statement” instructing the administration to provide the amounts for the areas specified.

See the table below for additional details on global health funding. See other budget summaries and the KFF budget tracker for details on historical annual appropriations for global health programs.

KFF Analysis of Global Health Funding in the FY 2026 Conference Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) Appropriations Bill (Table)
  1. Funding for FY25 was provided in a full-year Continuing Resolution (CR), which maintained FY24 levels. All FY25 amounts and associated notes are based on those specified in relevant FY24 appropriations bills. ↩︎
  2. The FY26 Request eliminates CDC’s Global Health Center and most of its bilateral programs, except funding for “Global Disease Detection & Emergency Response”, which is transferred to “Crosscutting Activities and Program Support”, and “Parasitic Diseases and Malaria”, which is transferred to “Emerging and Zoonotic Infectious Diseases”. ↩︎
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How State Policies Shape Access to Abortion Coverage

Editorial note: Updated February 2, 2026 with new updates for Delaware.

State and federal efforts to limit abortion coverage began soon after the 1973 Supreme Court’s Roe v Wade decision. In 1977, the Hyde Amendment banned federal funding for abortion, with exceptions for pregnancies that endanger the life of the woman, or result from rape or incest. Some states use their own funds to cover other medically necessary abortions for their Medicaid enrollees or have been compelled to do so by the courts. The passage of the ACA in 2010 led to renewed legislative efforts to limit abortion coverage, this time in private insurance plans. The ACA maintains the Hyde Amendment’s limits, and permits states to ban abortion coverage from Marketplace plans. Since 2010, many states have enacted private plan restrictions and also banned abortion coverage from Marketplace plans, some of which are more restrictive than the Hyde limitations. A handful of states, however, have enacted laws that require private plans to cover abortion and state funds to cover abortions for Medicaid enrollees.

The interactive map below shows the increase in states with laws restricting abortion coverage for Medicaid and private insurance enrollees in 2010 compared to the present.

Present
2010 – Passage of ACA
State Policies on Abortion Coverage for Medicaid, Private Insurance, and ACA Exchange Plan Enrollees – 2026 (Choropleth map)

On June 24, 2022, the Supreme Court overturned Roe v. Wade, eliminating the federal constitutional standard that had protected the right to abortion. States can now set their own policies to ban or protect abortion. As of January 6, 2026, 13 states have banned abortion (Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, North Dakota, Mississippi, Oklahoma, South Dakota, Tennessee, Texas, and West Virginia). For more details about legal status of abortion in states, please visit our Abortion in the United States Dashboard.

Medicaid Coverage Limitations (30 states & DC) – State limits Medicaid coverage of abortion to the Hyde Amendment restrictions (only allowed in the cases of rape, incest or life endangerment).

Private Insurance Coverage Limitations (10 states) – State has a law that prohibits coverage of abortions from being included in private insurance policies sold in the state (with certain exceptions). Private insurance includes individual, small group, and large group. Some states may allow abortion coverage to be purchased as a rider.

State Marketplace Coverage Limitations (25 states) – State has a law that prohibits plans sold on state Marketplaces from covering abortion (with certain exceptions).

No Coverage Limitations (6 states) – State does not limit coverage of abortion in private insurance or the state Marketplace and the state does not ban the use of state funds (non-federal) to pay for abortion for Medicaid enrollees in circumstances outside of those allowed by the Hyde Amendment.

Requires Abortion Coverage in Private and ACA Marketplace Plans and for Medicaid Enrollees (13 states) – State requires all fully-insured group plans and individual plans to include abortion coverage and state funds to cover abortion for Medicaid enrollees. Ten of these states require no cost-sharing for abortion—Illinois and Minnesota allow cost sharing if there is cost-sharing for similar services in the plan and Delaware prohibits cost-sharing for abortions up to $750.

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News Release

Poll: People View Prior Authorization as Greatest Burden in Navigating the Health System

Many Report Impact on their Care, Finances and Well-being

Published: Feb 2, 2026

New KFF polling explores the challenges beyond costs that people with insurance face in navigating the health care system. People cite prior authorization review as their top problem by a wide margin, with a third (32%) saying prior authorization requirements are a “major burden.”

That’s more than say the same about understanding their bill or what they owe (23% say it is a major burden), getting appointments when they need them (20%), or finding providers who accept their insurance (17%).

When asked to choose which of those four factors is “the single biggest burden,” prior authorization before accessing certain tests, treatments, or medication ranks at the top (34%). Among people with a chronic condition that requires ongoing medical treatment (about half of all insured adults), 4 in 10 (39%) say prior authorization is the single biggest burden when it comes to getting care, more than twice the share who say the same about other obstacles.

“The complexity of the health system drives patients crazy, can have real consequences, and disproportionately affects people who are sick,” KFF President and CEO Drew Altman said. “Prior authorization review is the poster child for that complexity.”

Prior authorization ranks as the single biggest burden for people with employer coverage and Medicaid, as well as those who buy their own coverage (largely through the Affordable Care Act’s Marketplaces).

During the prior authorization process, some treatments or medications recommended by a provider may be delayed and, in some instances, an insurance company may end up denying medication or treatment.

About half (47%) of insured adults – and a larger share (57%) of those with chronic conditions – say their access to a certain health care service, treatment, or medication has been denied, delayed, or altered in the past two years by their health insurer.

Among those who report such denials, delays, or alterations, about a third say it had a “major negative impact” on their mental health and emotional well-being (34%) and finances (33%), and a quarter say it had a “major negative impact” on their physical health (26%). This translates to about 1 in 5 of all adults with insurance saying that their mental or physical health, or finances, have been majorly impacted.

Designed and analyzed by public opinion researchers at KFF, this survey was conducted January 13-20, 2026, online and by telephone among a nationally representative sample of 1,426 U.S. adults in English and in Spanish. The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on other subgroups, the margin of sampling error may be higher.

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Craig Palosky

Poll Finding

KFF Health Tracking Poll: Prior Authorizations Rank as Public’s Biggest Burden When Getting Health Care

Published: Feb 2, 2026

News Release: Poll: People View Prior Authorization as Greatest Burden in Navigating the Health System

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Findings

As the latest KFF Health Tracking Poll shows, affordability is the public’s biggest concern, with the cost of health care ranking as their top economic worry. However, KFF polls have demonstrated that beyond costs, insured people report a whole host of issues navigating the health care system. This report looks at which aspects of accessing care and health insurance are the biggest problem for insured adults and finds that prior authorizations – or the process of having to get insurance approval before accessing certain tests, treatments, or medications – are having an outsized impact on insured adults.

One in three insured adults in the U.S. say they find prior authorizations a “major burden” to getting health care. An additional four in ten (37%) say the process is a “minor burden,” bringing the total share of insured adults who find the process burdensome to about seven in ten (69%). This is larger than the share who say other aspects are burdensome such as understanding bills or what is owed (60%), getting needed appointments (60%), or finding providers who accept their insurance (53%).

Stacked bar chart showing how much of a burden insured adults believe certain aspects of getting health care are.

When asked to choose which aspect of getting health care, beyond costs, is the single biggest burden, one in three insured adults (34%) choose prior authorizations, followed by getting needed appointments (19%), understanding their bill (17%), or finding providers who accept their insurance (15%). The choice of prior authorizations as the single biggest burden is even more stark among adults with a chronic condition that requires ongoing medical treatment (about half of all adults). These individuals often require more treatments and medications, resulting in more interactions with health insurance companies and health care providers. Four in ten (39%) insured adults with a chronic condition say prior authorizations are the single biggest burden when it comes to getting health care, at least twice the share who say the same about the other aspects of health care asked about.

Split bar chart showing how much of a burden insured adults and insured adults with a chronic condition believe certain aspects of getting health care are.

Prior authorizations are also identified as the single biggest burden for insured adults across partisans, as well as among individuals across insurance types that typically require prior authorizations such as individuals with Medicaid, people who buy their own health insurance, and people who get health insurance through an employer. Notably, about three in ten (28%) Medicaid enrollees identify finding providers who accept their insurance as the biggest burden, but small shares identify other issues as their biggest burden.1

A table showing the single biggest health care burden named by insured adults, broken out by insurance type and by party identification.

During the prior authorization process, some treatments or medications recommended by a provider may be delayed and, in some instances, an insurance company may end up denying medication or treatment. Overall, about two-thirds of adults say delays and denials of health care services by health insurance companies are a “major problem” with an additional one in four (24%) who say they are a “minor problem.” Just one in ten adults say delays and denials of services by insurance companies are not a problem in our current health care system.  More than six in ten across Medicaid enrollees, self-purchasers, and those with employer coverage say the delays and denials of care by insurance companies are a “major problem.”

A stacked bar chart showing how much of a problem adults view delays and denials of health care services by insurance companies.

About one in three insured adults (33%) say they have had a health insurance company deny coverage for a certain health care service treatment, or medication prescribed by their doctor in the past two years. Three in ten insured adults say that a health insurance company has delayed their ability to get such services, treatments, or medications (29%) or required them to try a lower-cost drug or treatment before covering the one that was originally recommended by their provider (29%). These issues are even more common among insured adults with a chronic condition with about four in ten reporting that an insurance company has required them to try a lower-cost drug or treatment (38%), deny coverage for a certain service or medication (42%), or delayed their ability to get prescribed care (37%). Overall, nearly half (47%) of insured adults say they have had a certain service, treatment, or medication either denied or delayed in the past two years, rising to nearly six in ten (57%) among those with a chronic condition.

Split bar chart showing the share of insured adults and insured adults with a chronic condition who say they've experienced issues with their health insurance company.

Denial and delays by health insurance companies can lead to negative consequences for people’s physical, mental, and financial health. One in three of those who experienced a denial or delay say the actions required by their health insurance company had a “major negative impact” on their mental health and emotional well-being as well as on their finances (about one in six of all insured adults).  One in four (one in eight of all insured adults) say the delays or denials has a “major negative impact” on their physical health.

A stacked bar chart showing how much of an impact issues with prior authorizations have had on insured adults, broken out by those who said they had previous experience with this and among total insured adults.

 

  1. Prior authorization is more common in Medicare Advantage than Traditional Medicare. Because this analysis is unable to break out individuals with traditional Medicare versus Medicare Advantage, we do not include Medicare as a subgroup in our analysis. These individuals are included in both the total group and the group with chronic conditions.  To learn more about prior authorizations for Medicare, more available at https://www.kff.org/medicare/medicare-advantage-insurers-made-nearly-53-million-prior-authorization-determinations-in-2024/. ↩︎

Methodology

This KFF Health Tracking Poll/KFF Tracking Poll on Health Information and Trust was designed and analyzed by public opinion researchers at KFF. The survey was conducted January 13-20, 2026, online and by telephone among a nationally representative sample of 1,426 U.S. adults in English (n=1,355) and in Spanish (n=71). The sample includes 1,028 adults (n=60 in Spanish) reached through the SSRS Opinion Panel either online (n= 1,003) or over the phone (n=25). The SSRS Opinion Panel is a nationally representative probability-based panel where panel members are recruited randomly in one of two ways: (a) Through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Groups (MSG) through the U.S. Postal Service’s Computerized Delivery Sequence (CDS); (b) from a dual-frame random digit dial (RDD) sample provided by MSG. For the online panel component, invitations were sent to panel members by email followed by up to three reminder emails. 

Another 398 (n=11 in Spanish) adults were reached through random digit dial telephone sample of prepaid cell phone numbers obtained through MSG. Phone numbers used for the prepaid cell phone component were randomly generated from a cell phone sampling frame with disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents. Stratification was based on incidence of the race/ethnicity groups within each frame. Among this prepaid cell phone component, 149 were interviewed by phone and 249 were invited to the web survey via short message service (SMS). 

Respondents in the prepaid cell phone sample who were interviewed by phone received a $15 incentive via a check received by mail or an electronic gift card incentive. Respondents in the prepaid cell phone sample reached via SMS received a $10 electronic gift card incentive. SSRS Opinion Panel respondents received a $5 electronic gift card incentive (some harder-to-reach groups received a $10 electronic gift card). In order to ensure data quality, cases were removed if they failed two or more quality checks: (1) attention check questions in the online version of the questionnaire, (2) had over 30% item non-response, or (3) had a length less than one quarter of the mean length by mode. Based on this criterion, 2 cases was removed. 

The combined cell phone and panel samples were weighted to match the sample’s demographics to the national U.S. adult population using data from the Census Bureau’s 2025 Current Population Survey (CPS), September 2023 Volunteering and Civic Life Supplement data from the CPS, and the 2025 KFF Benchmarking Survey with ABS and prepaid cell phone samples. The demographic variables included in weighting for the general population sample are gender, age, education, race/ethnicity, region, civic engagement, frequency of internet use and political party identification. The weights account for differences in the probability of selection for each sample type (prepaid cell phone and panel). This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure. 

The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available on request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research. 

GroupN (unweighted)M.O.S.E.
Total1,426± 3 percentage points
 
Party ID
Democrats473± 6 percentage points
Independents483± 6 percentage points
Republicans367± 6 percentage points
  
MAGA Republicans/Rep leaners352± 6 percentage points
MAHA supporters618± 5 percentage points
Parents or guardians of children under 18 living in their household436± 6 percentage points
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