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.

In December 2019, a federal appeals court panel ruled that the law’s individual mandate is unconstitutional since Congress has set the mandate tax penalty to zero and sent the case back to a lower court to determine how much of the rest of the ACA should be invalidated. The case was first brought by a number of Republican state attorneys general, and the Trump administration now argues that nearly all of the ACA should be overturned. The U.S. Supreme Court has now agreed to review the case.

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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Analysis of 2016 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces

The chart and tables below present an updated analysis of changes in premiums for the lowest- and second-lowest cost silver Affordable Care Act (ACA) marketplace plans in major cities in 48 states and the District of Columbia, where we were able to find complete data on rates for all insurers. This page will be updated as complete rate information becomes available for more states. More background can be found in our earlier analysis of 2016 rates.

Estimates of Eligibility for ACA Coverage among the Uninsured by Race and Ethnicity

This analysis provides national estimates of eligibility for ACA coverage options by race/ethnicity, including Whites, Blacks, and Hispanics. We estimate coverage and eligibility as of early 2015, which is prior to the end of the 2015 Marketplace open enrollment period. Overall, this analysis finds that more than half (55%) of the total 32.3 million nonelderly uninsured are people of color, including 34% who identify as Hispanic, 14% who identify as Black, and 8% who identify as another group or mixed race.

How Health Care Factors Into the Presidential Campaign

In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses how health care issues have cooled in the election season but matter more for certain voting groups than others, and for “health care voters” encompass more than the Affordable Care Act.

Kaiser Health Tracking Poll: December 2015

The ACA’s third open enrollment will come to a close at the end of January and the December Kaiser Health Tracking Poll finds that only 7 percent of the uninsured correctly identify this as the deadline to enroll in coverage. With Democratic presidential candidates debating the idea of Medicare-for-all, which involves creating a national health plan in which all Americans would get their insurance through an expanded version of the Medicare program, most Democrats like the idea, but very few say the issue will drive their votes in the 2016 elections. As the U.S. Senate voted to repeal the Affordable Care Act (ACA) earlier this month, more of the public views the health care law unfavorably than favorably (46 percent vs. 40 percent). In addition, the public remains divided over what Congress should do next with the law, with 35 percent supporting repeal, 14 percent supporting scaling back the law, 18 percent who say they would like to see it implemented as is, and 22 percent who say they want the law expanded.

Potential Savings from Actively Shopping for Marketplace Coverage in 2016

This analysis looks at how the premiums for the lowest-cost silver plans in Affordable Care Act (ACA) Marketplaces changed between 2015 and 2016. The analysis examines premiums of the 2015 lowest-cost silver plans (in states that used Healthcare.gov in both 2015 and 2016) for a single 40 year-old adult to see how much these premiums increase in 2016 and whether enrollees could obtain lower premiums by switching plans.

Key Data on Health and Health Coverage in South Carolina

This fact sheet draws on data from “Health and Health Coverage in the South: A Data Update” to highlight findings for South Carolina. The findings show the current status of health and health coverage in the state and the potential coverage gains that may be achieved through the Affordable Care Act.

Assessing ACA Marketplace Enrollment

This analysis examines factors that may have kept 2016 enrollment in Affordable Care Act (ACA) marketplace plans from reaching early projections, and it estimates that sign-ups will continue to grow modestly in coming years.

A Closer Look at the Remaining Uninsured Population Eligible for Medicaid and CHIP

The Affordable Care Act (ACA) extends health insurance coverage to people who lack access to an affordable coverage option. Under the ACA, as of 2014, Medicaid coverage is extended to low-income adults up to 138% of the Federal Poverty Level (FPL) in states that have opted to expand eligibility, and tax credits are available for middle-income people who purchase coverage through a health insurance Marketplace. Millions of people have enrolled in these new coverage options, but millions of others are still uninsured. Recent analysis shows that 28% or 8.8 million of the 32.3 million non-elderly uninsured are eligible for Medicaid coverage. This issue brief provides a closer look at key characteristics of the uninsured who are eligible for Medicaid and where they live. Analysis is based on state Medicaid expansion decisions as of January 2016 which includes Louisiana’s decision to adopt the expansion. These data may help inform outreach and enrollment efforts to increase coverage gains among the eligible but uninsured population.

Proposed Changes to Medicaid Expansion in Kentucky

On June 22, 2016, Governor Bevin released his proposed Section 1115 demonstration waiver application called Kentucky HEALTH (Helping to Engage and Achieve Long Term Health) as an alternative to the current Medicaid expansion which is being implemented through a state plan amendment according to the terms in the ACA. On July 3, 2017, Kentucky submitted an amendment, proposing several changes, to its pending waiver application to the new Administration. This fact sheet summarizes the proposed changes to the current Medicaid expansion in Kentucky.

Summary of HHS’s Final Rule on Nondiscrimination in Health Programs and Activities

On May 18, 2016, the Department of Health and Human Services (HHS) published a final rule to implement Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination in health coverage and care based on race, color, national origin, age or disability, and, for the first time sex. This Issue Brief provides a technical summary of Section 1557 and the final rule and highlights new protections and provisions included in the law and rule. Notably, Section 1557 is the first federal civil rights law to prohibit discrimination on the basis of sex in health care. Moreover, the proposed rule extends the definition of sex discrimination to include discrimination on the basis of gender identity. In addition, the final rule establishes regulations related to the provision of language assistance services based on long-standing HHS policy guidance.