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In total, due to the One Big Beautiful Bill Act and other policy changes, the number of people without health insurance is expected to increase by about 17 million. If all of this comes to pass, it would represent the biggest roll back of health insurance coverage ever due to federal policy changes.

Section 1115 Medicaid waivers can allow states to test new approaches in Medicaid that differ from what is required by federal law. This page tracks approved and pending waiver provisions (including expansions and restrictions) related to eligibility, benefits, and social determinants of health and other delivery system reforms.

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KFF is tracking the Affordable Care Act (ACA) provisions in the 2025 federal budget bill, including changes related to enrollment, verifying eligiblity, and filing and reconciliation.

KFF is tracking the Health Savings Accounts provisions included in the 2025 federal budget reconciliation bill. The House-passed bill includes several changes, while the proposed Senate bill does not address HSAs.

Explore KFF’s policy research, polling and news on changes to the Affordable Care Act (ACA), efforts to address drug costs, and other debates about reforming federal and state health insurance programs

Data on MCOs and managed care firms

This analysis allocates the CBO’s estimated reduction in federal spending in the Senate reconciliation bill across states based on KFF’s state-level data and where possible, prior modeling work; and shows the federal spending reductions relative to KFF’s projections of federal spending by state under current law.

Prior KFF analysis allocated CBO’s federal Medicaid spending reductions and enrollment losses across the states, and this policy watch builds on that analysis to examine the potential impacts in expansion states compared with non-expansion states.