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A promotional image for the the KFF Health Policy 101 Health Care Costs and Affordability chapter

Health Policy 101 is a comprehensive guide covering fundamental aspects of U.S. health policy and programs, including Medicare, Medicaid, the Affordable Care Act, employer-sponsored insurance, the uninsured population, health care costs and affordability, women's health issues, and health care politics. The Health Care Costs and Affordability 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 across the population, the impact of costs on care affordability and individuals' overall financial vulnerability.

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  • Disparities in Access to Air Conditioning And Implications for Heat-Related Health Risks

    Issue Brief

    This analysis examines disparities in access to air condition and their implications. It shows Asian-, Black-, and Hispanic-led households are more likely to report not having an air conditioning unit in their home compared to White households. Lower income households also are more likely than higher-income households to report this and other challenges.

  • How Many People with Employer-Sponsored Insurance Use the Drugs Slated for Medicare Price Negotiations

    Issue Brief

    Among the 167 million people with employer-sponsored insurance in 2022, 3.4 million used at least one of the first 10 drugs identified for Medicare price negotiations, according to a new analysis. The most used drug for people with employer-sponsored health insurance was Jardiance, a drug used to treat diabetes and heart failure, which was taken by more than 911,000 enrollees. The analysis uses the Merative MarketScan 2022 commercial claims to estimate the number of enrollees…

  • Insurer Strategies to Control Costs Associated with Weight Loss Drugs

    Issue Brief

    Affordable Care Act (ACA) Marketplace plans rarely cover GLP-1 drugs approved solely for obesity treatment, according to a an analysis of 2024 federal plan data. Wegovy, a drug that is approved for weight loss, is covered by just 1% of Marketplace prescription drug plans, compared to 82% of Marketplace prescription drug plans for Ozempic, which contains the same active ingredient as Wegovy (semaglutide) but is approved only for diabetes. This analysis examines publicly available formularies…

  • How Many Adults with Private Health Insurance Could Use GLP-1 Drugs

    Issue Brief

    More than two in five (42%) or 57.4 million adults under 65 with private insurance could be eligible under clinical criteria for GLP-1 drugs used to treat people with type 2 diabetes, obesity, or excess weight and weight-related health issues, according to a new KFF analysis. Though only about 3% of adults with employer coverage had a prescription in 2022, demand for and spending on GLP-1 drugs has grown and could continue to grow. Given…

  • A Backlash Against Health Insurers, Redux

    Perspective

    In this JAMA Health Forum post, Executive Vice President Larry Levitt recalls the mid-1990s’ public backlash against Health Maintenance Organizations (commonly known as HMOs) – all of which preceded the recent outpouring of health insurance concerns – as well as how consumer protections against coverage restrictions have evolved and fallen short.

  • Lessons From the Election About Voters and Health

    From Drew Altman

    In this column, KFF president and CEO Drew Altman explores why health costs weigh heavily among voters' economic concerns, even in an election where health was not a flashpoint. The need to reframe health as a pocketbook issue for voters will be central to the competition for the votes of working class Latino voters, two groups very focused on the cost of living.

  • With or Without ACA Repeal, ACA and Medicaid Cuts are Looming

    Perspective

    In this JAMA Health Forum post, Executive Vice President Larry Levitt explores why the incoming Trump administration and Republican majorities in Congress are likely to pursue budget cuts in Medicaid and the Affordable Care Act and why such efforts are likely to boost the number of uninsured Americans.

  • Kaiser Calculator Now Gives Consumers 2015 Zip Code-Specific Premium and Tax Credit Estimates for Marketplace Coverage

    News Release

    The Kaiser Family Foundation's Health Insurance Marketplace Calculator now includes zip code-specific data on 2015 health plans that are being sold through the Affordable Care Act’s insurance marketplaces during the open enrollment period beginning Saturday, Nov. 15. With the new tool, consumers around the nation can generate estimates of their health insurance premiums and government subsidies for 2015 plans that they purchase on their own through an ACA marketplace. The estimates are based on zip…

  • Estimating Federal Payments and Eligibility for Basic Health Programs: An Illustrative Example

    Report

    In some states, policymakers and stakeholders are considering adoption of the Basic Health Program (BHP) option permitted under the Patient Protection and Affordable Care Act (ACA). Federal regulations allow BHP implementation beginning in 2015. Through BHP, consumers with incomes at or below 200 percent of the federal poverty level (FPL) who would otherwise qualify for subsidized qualified health plans (QHPs) offered in health insurance marketplaces instead are offered state-contracting standard health plans that provide coverage…