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Affordable Care Act

Updated Larry QT on ePTCs

There is No Drop-Dead Date for an ACA Tax Credit Extension, But Coverage Losses Will Mount as the Clock Ticks

While the Affordable Care Act’s enhanced premium tax credits expired at the end of 2025, there is no absolute drop-dead date for extending them. An extension could happen even after the deadline to sign up for coverage and be made retroactive to January 1. Open enrollment could also be extended to allow people time to change their plans or allow new people to sign up. ACA enrollees would welcome premium relief whenever it comes, explains KFF's Larry Levitt.

ACA Signups Are Down, But Still an Incomplete Picture

Data currently being released represent Open Enrollment ACA Marketplace plan selections, or how many people have signed up for or been automatically renewed into 2026 coverage. These data do not necessarily translate to enrollments. That is because people who have selected a plan or been automatically renewed may not ultimately choose to pay for their coverage, thus “effectuating” their enrollment.

health system tracker
KEY RESOURCES

  • Health Policy 101: Costs and Affordability

    This Health Policy 101 chapter explores trends in health care costs in the U.S. and the factors that contribute to this spending. It also examines how health care spending varies and the impact on affordability and people's overall financial vulnerability.  


  • Americans’ Challenges with Health Care Costs

    This data note reviews our recent polling data that finds that Americans struggle to afford many aspects of health care, including disproportionate shares of uninsured adults, Black and Hispanic adults and those with lower incomes.

  • National Health Spending Explorer

    This interactive Peterson-KFF Health System Tracker tool allows users to examine five decades worth of data on health expenditures by federal and local governments, private insurers, and individuals.

  • Polling on Prescription Drugs and Their Prices

    This chart collection draws on recent KFF poll findings to provide an in-depth look at the public’s attitudes toward prescription drugs and their prices. Results include Americans’ opinions on drug affordability, pharmaceutical companies, and various potential measures that could lower prices.

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  • What an Income Cap Could Mean for ACA Enrollees and the Federal Budget

    Quick Take

    Some members of Congress are considering an income cap on the ACA enhanced premium tax credits to lower federal costs. Depending on the income cutoff chosen, a cap may have little effect on the federal budget and a big effect on some households’ budgets, particularly for older enrollees.

  • How Might Expiring Premium Tax Credits Impact People with HIV?

    Issue Brief

    This issue brief provides an overview of the potential impact not extending enhanced ACA premium tax credits could have on people with HIV and the Ryan White HIV/AIDS Program. Enhanced credits have improved insurance coverage affordability for millions of people, including those with HIV. People with HIV may be particularly vulnerable, given that they are more likely to have Marketplace plans and many also rely on the federally-funded Ryan White HIV/AIDS Program to help cover plan costs. Loss of coverage and increased costs could lead to disruptions in care for people with HIV which could have serious implications for individual and public health.

  • What to Know About How Medicare Pays Physicians

    Issue Brief

    Each year, the Centers for Medicare & Medicaid Services (CMS) updates Medicare payments for physician services and other Part B services through rulemaking. This issue brief answers key questions about how physicians are paid under the Medicare program, and reviews policy options under discussion for payment reform.

  • How Does the Quality of the U.S. Health System Compare to Other Countries?

    Feature

    This chart collection compare health outcomes, quality of care, and access to services between the U.S. and peer countries. While inconsistent and imperfect metrics make it difficult to firmly assess system-wide health quality in the U.S., a review of the available data prior to the onset of the COVID-19 pandemic suggests that in most of these measures, the U.S. has lagged behind comparably large and wealthy countries.

  • KFF Health Tracking Poll: Public Weighs Political Consequences of Health Policy Legislation

    Poll Finding

    KFF's Health Tracking Poll finds that more than three-quarters of the public say they want Congress to extend the ACA enhanced premium tax credits that are set to expire at the end of this year. If the credits do expire and the average premium more than doubles, seven in 10 of those who purchase their own insurance say they would not be able to afford premiums without significantly disrupting their household finances.

  • International Comparison of Health Systems

    Feature

    This Health Policy 101 chapter explores the performance of the U.S. health system on a number of cost, outcomes, and quality measures by comparing it with those in similarly large and wealthy OECD nations. It highlights that despite significant spending, Americans have shorter life expectancies and encounter more barriers to health care, influenced by both the health system's structure and broader socioeconomic factors.