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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Related Affordable Care Act Resources

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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September 24, 2013 Issue Brief

Getting into Gear for 2014: Insights from Three States Leading the Way in Preparing for Outreach and Enrollment in the Affordable Care Act

This report provides insight into preparations in Maryland, Nevada, and Oregon -three states that have established a State-based Marketplace, are moving forward with the Medicaid expansion, and are among the states leading the way in preparing for outreach and enrollment. e findings provide an overview of where these three states are in establishing their Marketplaces; preparing for the Medicaid expansion; planning for marketing, outreach and enrollment; and establishing enrollment assistance resources. It highlights the challenges the states have encountered and overcome, the successes they have achieved, and provides key lessons that may help inform implementation efforts moving forward.

September 24, 2013 Issue Brief

Providing Outreach and Enrollment Assistance: Lessons Learned from Community Health Centers in Massachusetts

As states and communities gear up to provide outreach and enrollment assistance under the ACA, the enrollment assistance experience of health centers in Massachusetts, where a major expansion of health coverage was implemented six years ago, offers valuable lessons that can help to inform current and emerging efforts by health centers and other community-based organizations to reach and enroll millions of low-income, uninsured Americans in health insurance.

September 10, 2013 Issue Brief

Health Affairs Article: Medicaid Expansion: Chronically Homeless Adults Will Need Targeted Enrollment and Access to a Broad Range of Services

Homeless adults may gain access to health services under the Affordable Care Act’s Medicaid expansion, which takes effect in 2014. This study, published in Health Affairs, analyzed the health coverage, health status, and health services use of 725 chronically homeless adults with disabilities in eleven cities in the United States.

August 29, 2013 Issue Brief

Health Reform: Implications for Women’s Access to Coverage and Care

This issue brief, Health Reform: Implications for Women’s Access to Coverage and Care, reviews how the Affordable Care Act is expected to affect access to care and affordability of health coverage for women. It also explains the provisions in the health reform law related to preventive screening services, reproductive health, maternity care and women on Medicare. The brief includes national and state-level estimates of the percentage of uninsured women ages 18-64 who are likely to qualify for federal help under the law and a summary of key coverage and benefits provisions in the health reform law that affect women.

August 28, 2013 Poll Finding

Kaiser Health Tracking Poll: August 2013

As outreach efforts for enrollment in the health insurance marketplaces created by the Affordable Care Act (ACA) increase over the summer, the August Kaiser Health Tracking Poll finds that the public’s most trusted sources of information on the law are not necessarily the ones people are most likely to be hearing from.

August 15, 2013 Issue Brief

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.

August 14, 2013 Issue Brief

Quantifying Tax Credits for People Now Buying Insurance on Their Own

This analysis estimates that Americans currently buying insurance on the individual market would receive $2700 in subsidies (as tax credits) in 2014 under Obamacare. Tax credits are available for qualifying people buying insurance through the new health care marketplaces, or exchanges.

August 2, 2013 Issue Brief

What is Medicaid’s Impact on Access to Care, Health Outcomes, and Quality of Care? Setting the Record Straight on the Evidence

Medicaid now covers more than 1 in every 5 Americans, and millions of uninsured individuals will become newly eligible for Medicaid under the ACA. Considering Medicaid’s large and growing coverage role, an evidence-based assessment of the program’s impact on access to care, health outcomes, and quality of care is of major interest. This brief takes a look at what the research literature shows regarding the difference Medicaid makes.

July 31, 2013 Issue Brief

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.

July 31, 2013 Report

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.