President Donald Trump and Republicans in Congress pursued several major efforts to repeal and replace the Affordable Care Act (ACA) but were unable to get a bill through the U.S. Senate in 2017. In 2018, Congress did pass a tax bill that eliminated the ACA’s tax penalty for not obtaining health coverage beginning in 2019. The Trump Administration’s actions and decisions also have affected the ACA marketplaces and will continue to reshape how Americans get health insurance into 2019 and beyond.

For information about ACA Marketplace Open Enrollment, including fact sheets and 300+ FAQs, visit our collection of resources on Understanding Health Insurance.

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Kaiser Health Tracking Poll: April 2013

With open enrollment in new health coverage options created under the Affordable Care Act set to begin in October, much of the public remains confused about the status of the law. The April 2013 Kaiser Health Tracking Poll provides a rough baseline of public awareness of the ACA before more intensive consumer information and consumer assistance efforts begin.

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The Henry J. Kaiser Family Foundation

Getting into Gear for 2014: Findings From a 50-State Survey of Eligibility, Enrollment, Renewal and Cost-Sharing Policies in Medicaid and CHIP, 2012-2013

This 50-state survey provides a snapshot of Medicaid and CHIP enrollment and eligibility policies and procedures and highlights the changes that states will need to make in their programs to prepare for the ACA in 2014.

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The Henry J. Kaiser Family Foundation

JAMA Forum: Great Expectations and the Affordable Care Act

“Great Expectations and the Affordable Care Act,” Larry Levitt’s February 2013 post for The JAMA Forum, is now available online.

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The Henry J. Kaiser Family Foundation

Health Coverage by Race and Ethnicity: The Potential Impact of the Affordable Care Act

Executive Summary One of the key goals of the Affordable Care Act (ACA) is to reduce the number of uninsured through a Medicaid expansion and the creation of health insurance exchange marketplaces with advance premium tax credits to help moderate-income individuals pay for this coverage. Given that people of color…

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The Henry J. Kaiser Family Foundation

A Discussion with Leading Medicaid Directors: As FY 2013 Ends, Looking toward Health Care Reform Implementation in 2014

The Kaiser Commission on Medicaid and the Uninsured convened a focus group discussion with Medicaid directors who serve on the Board of the National Association of Medicaid Directors (NAMD). The discussion focused on state progress and concerns about implementing the ACA including eligibility system changes and state action on the Medicaid expansion decision as well as activity around payment and delivery system reform, and other budget and enrollment trends. The discussion took place in May 2013. Nine Medicaid directors from the NAMD Board plus the Michigan Medicaid Director and NAMD staff participated in the discussion. The following states were represented: Arizona, California, Georgia, Indiana, Michigan, South Carolina, Tennessee, Virginia, Washington, and West Virginia.

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Beyond Rebates: How Much Are Consumers Saving from the ACA’s Medical Loss Ratio Provision?

The Medical Loss Ratio (MLR) provision of the Affordable Care Act (ACA) saved consumers an estimated $2.1 billion last year, in the form of lower premiums and rebates, according to a new analysis by the Kaiser Family Foundation. Under health reform, insurers must issue consumer rebates if they fail to spend a certain portion of premium income on health care claims and quality improvement expenses, thereby limiting what they may spend on administrative expenses or keep as profits.

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The Henry J. Kaiser Family Foundation

State and Local Coverage Changes Under Full Implementation of the Affordable Care Act

This brief highlights estimates from the Urban Institute’s ACS-HIPSM on the magnitude and composition of Medicaid enrollees and the uninsured after full implementation of the Affordable Care Act (ACA), including the Medicaid expansion. Both state and local level estimates highlight the geographic variation.

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The Henry J. Kaiser Family Foundation

Aligning Eligibility for Children: Moving the Stairstep Kids to Medicaid

The Affordable Care Act (ACA) requires that Medicaid cover children with incomes up to 133 percent of the federal poverty level (FPL) ($31,322 for a family of four in 2013) as of January 2014. Today, there are “stairstep” eligibility rules for children. States must cover children under the age of six in families with income of at least 133 percent of the FPL in Medicaid while older children and teens with incomes above 100 percent of the FPL may be covered in separate state Children’s Health Insurance Programs (CHIP) or Medicaid at state option. While many states already cover children in Medicaid with income up to 133 percent FPL, due to the change in law, 21 states needed to transition some children from CHIP to Medicaid. This brief examines how the transition of children from CHIP to Medicaid will affect children and families as well as states. The brief also looks to New York and Colorado for lessons learned from the early transition of coverage.

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The Henry J. Kaiser Family Foundation

The Role of Medicaid in State Economies and the ACA

This brief summarizes findings from 32 studies in 26 states analyzing the anticipated impact of the Affordable Care Act Medicaid expansion (and in some cases full ACA implementation) on state and local economies.

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The Henry J. Kaiser Family Foundation

Summary of Coverage Provisions in the Patient Protection and Affordable Care Act

This short summary describes the health coverage provisions contained in the final version of the Affordable Care Act signed into law in March 2010, including the individual mandate requirements, expansion of public programs, health insurance exchanges, changes to private insurance and employer requirements.

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