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This analysis looks at the share of family income people with employer-based coverage pay toward their premiums and out-of-pocket payments for medical care. The cost of employer sponsored health insurance—including premiums, deductibles, and other out-of-pocket costs—has risen steadily over time.

This brief evaluates what is currently known about fraud and abuse in the Affordable Car Act (ACA) Marketplace, including how the final Marketplace Integrity and Affordability Rule and proposed budget reconciliation legislation would change existing Marketplace enrollment and eligibility standards.

On June 27, 2025, the U.S. Supreme Court issued its opinion on Kennedy v. Braidwood Management, ruling that the ACA requirement that most private insurers and Medicaid expansion programs to cover preventive services recommended by the United States Preventive Services Preventive Task Force (USPSTF) with no cost-sharing is constitutional.

This analysis estimates that the House-passed reconciliation bill could lead Medicaid spending in rural areas to decrease by $119 billion and a 1.5 million drop in enrollment over 10 years.

The Supreme Court’s ruling in Medina v. Planned Parenthood of the South Atlantic means that Medicaid enrollees in South Carolina, and in other states that exclude Planned Parenthood going forward, will not be able to use their Medicaid coverage to obtain any preventive services, such as contraceptive care, STI treatment and cancer screenings, at Planned Parenthood clinics.

This brief estimates the number of current Marketplace enrollees with a mental health diagnosis to understand what changes in enrollment may mean for access to services. Among the 24.3 million Marketplace enrollees in 2025, over 4.4 million individuals are estimated to have at least one mental health diagnosis on a health care claim.

The Senate Finance Committee’s reconciliation language would reduce existing state-directed payments to hospitals and nursing facilities over time until they are at or slightly above Medicare rates.  This analysis identifies states that might have to reduce payment rates for hospitals or nursing facilities if the language is passed into law.

This brief uses 2021 Medicaid claims data to examine utilization among Medicaid expansion adults and estimate how much cost sharing these enrollees could be required to pay under the new requirement if all states imposed the maximum cost sharing amounts. This is an illustrative analysis intended to describe which enrollees may be subject to the most cost sharing under the new provisions rather than estimate exactly what expansion enrollees may actually pay.