More than a decade after its enactment, the future of the Affordable Care Act (ACA) remains uncertain as the U.S. Supreme Court takes up another challenge to the law’s constitutionality in California v. Texas (known as Texas v. U.S. in the lower courts). Oral argument is scheduled for Tuesday, November 10, 2020.

The ACA remains in effect while the litigation is pending. However, if all or most of the law ultimately is struck down, it will have complex and far-reaching consequences for the nation’s health care system, affecting nearly everyone in some way.

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

Featured Affordable Care Act Resources

Sep 1, 2020

Explaining California v. Texas: A Guide to the Case Challenging the ACA

This issue brief answers key questions about California v. Texas (known as Texas v. US in the lower courts), the case challenging the Affordable Care Act to be heard by the Supreme Court.

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Sep 22, 2020

Potential Impact of California v. Texas Decision on Key Provisions of the Affordable Care Act

The Supreme Court will review the constitutionality of the Affordable Care Act (ACA) this November in California v. Texas. This fact sheet summarizes the major provisions of the ACA, illustrating the breadth of its changes to the health care system. If all of most of the ACA is struck down, many of these provisions could be eliminated.

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August 11, 2017 Poll Finding

Kaiser Health Tracking Poll – August 2017: The Politics of ACA Repeal and Replace Efforts

Following the U.S. Senate’s failed vote on the “skinny repeal”, the latest Kaiser Health Tracking Poll finds that the majority of the public say it is a “good thing” that the Senate did not pass the bill that would have repealed and replaced the ACA. A large share of Americans think President Trump and his administration should do what they can to make the current health care law work and a majority of the public want to see bipartisan efforts to improve the 2010 health care law. However, about half of Republicans and Trump supporters would like to see Republicans in Congress keep working on a plan to repeal the ACA, and most Republicans and Trump supporters endorse using hard-ball tactics to encourage Democrats to start negotiating with President Trump on a replacement plan. The majority of the public are also unaware that health insurance companies choosing not to sell insurance plans or charging higher premiums in certain marketplaces only affect those who purchase their own insurance on these marketplaces.

August 24, 2017 Poll Finding

Data Note: Strongly Held Views on the ACA

Since the passage of the Affordable Care Act in 2010, Kaiser Family Foundation polling has found the public divided in their overall views of the law. At the same time, an intensity gap in opinion has existed since 2010, with the share of the public holding strongly unfavorable views of the law outnumbering the share with strongly favorable views. A new analysis of Kaiser Family Foundation polling data finds that intensity gap began to close in spring 2017. The share with a “very favorable” view is now roughly equal to the share with a “very unfavorable” view.

April 30, 2015 Issue Brief

Evolving Picture of Nine Safety-Net Hospitals: Implications of the ACA and Other Strategies

Safety-net hospitals are an integral part of the U.S. health care landscape, providing care to some of the nation’s most medically vulnerable populations, including Medicaid enrollees and the uninsured. With the implementation of the Affordable Care Act (ACA), the U.S. health care system is rapidly changing, and safety-net hospitals need to make major adjustments to survive in the post-reform environment. This brief draws on interviews with executives at nine safety-net hospital systems and examines how their hospitals have fared since major coverage provisions of the ACA came into effect in January 2014. The brief also examines new and ongoing strategies that the hospitals are adopting in the face of a quickly changing health care environment. While acknowledging the importance of the ACA, executives at each system in the study noted that other non-ACA related factors have also shaped how their hospitals fared over the last year. The hospitals in the study were: Cook County Health and Hospital System (CCHHS); Denver Health (Denver Health); Harris Health System (Harris Health); New York City Health and Hospitals Corporation (HHC); Parkland Health and Hospital System (Parkland); Santa Clara Valley Health and Hospital System (SCVHHS); San Francisco General Hospital (SFGH); University Medical Center of Southern Nevada (UMC), and Virginia Commonwealth University Health System (VCU). These hospitals participated in two earlier related studies that examined how the systems were preparing for health care reform.

May 4, 2015 Perspective

Americans’ Health Priorities Diverge From Washington’s Focus on Obamacare

In this column for The Wall Street Journal’s Think Tank, Drew Altman finds the public’s healthcare priorities have more to do with drug costs and other real world issues people deal with using the health care system than the ongoing partisan wrangling over the Affordable Care Act (ACA).

May 21, 2015 Poll Finding

Survey of Non-Group Health Insurance Enrollees, Wave 2

The survey is the second in a series exploring the experiences and perceptions of people who purchase their own health insurance, the group perhaps most affected by the Affordable Care Act’s reforms to the individual insurance market and tax subsidies to make such coverage more affordable. It includes people in ACA-compliant plans sold both inside and outside the federal and state marketplaces, as well as those still in non-compliant plans, which took effect prior to January 2014 and in many cases do not comply with all the law’s requirements.

June 18, 2015 Poll Finding

Experiences And Attitudes Of Primary Care Providers Under The First Year Of ACA Coverage Expansion

A new survey from The Kaiser Family Foundation and The Commonwealth Fund asked primary care providers—physicians, nurse practitioners, and physician assistants—about their views of and experiences with the Affordable Care Act (ACA) and other changes in health care delivery and payment, as well as their thoughts on the future of primary care.

June 24, 2015 Issue Brief

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

This analysis provides an early look at premium changes for individuals in the health insurance marketplaces, created under the Affordable Care Act (ACA), in major cities in 10 states plus DC. Premium changes for the benchmark silver plans vary significantly across the sample cities. The benchmark rates will increase 4.4 percent on average in 2016 without accounting for tax credits, a relatively modest amount but greater than the average increase for 2015.

July 1, 2015 Poll Finding

Kaiser Health Tracking Poll: Late June 2015 – A Special Focus On The Supreme Court Decision

The latest Kaiser Health Tracking Poll finds that when told that the U.S. Supreme Court ruled to keep the Affordable Care Act (ACA) as it is, allowing subsidies to be provided to low- and moderate-income people in all states regardless of who runs their Marketplace, about 6 in 10 say they approve of the decision while about a third disapprove. The King v. Burwell ruling does not appear to have had an immediate effect on the public’s overall views of the health law. Still, most Americans do not think the ACA has cleared its last big hurdle with the June 25 Supreme Court ruling; just 18 percent think the King v. Burwell case was the last major battle over the ACA, while nearly 8 in 10 think there will be more to come.

December 4, 2017 Issue Brief

Implications of Navigator Funding Changes on People with HIV: Navigator Perspectives

This issue brief analyzes funding data and findings from stakeholder interviews with navigators serving people with HIV to assess the potential impact of navigator grant cuts on this population.

December 5, 2017 Perspective

ACA Mandate Repeal May Be Less Popular Than GOP Thinks

In this Axios column, Drew Altman discusses how public opinion seems to flip on eliminating the individual mandate as part of the tax legislation, from for it to against, when the public considers the consequences.