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.

Featured Affordable Care Act Resources

Oct 16, 2019

FAQs: Health Insurance Marketplace and the ACA

This list of more than 300 Frequently Asked Questions (FAQs) covers the Affordable Care Act’s health insurance Marketplace (aka exchange), individual mandate, open enrollment, premiums and more. It provides answers to questions about specific groups, such as young adults, smokers, the uninsured, and non-traditional households.

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Related Affordable Care Act Resources

Jan 3, 2020

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

On December 14, 2018, a federal trial court judge ruled that the Affordable Care Act’s (ACA) individual mandate is unconstitutional and that the entire law should be struck down as a result. This brief considers the complex and far-reaching impact were the entire law ultimately held to be invalid.

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December 10, 2019 Issue Brief

How Many of the Uninsured Can Purchase a Marketplace Plan for Free in 2020?

This analysis looks at how many of the remaining uninsured are eligible for premium subsidies that are large enough to cover the entire cost of a bronze plan, which is the minimum level of coverage available on the Marketplaces. It estimates 28% of uninsured individuals who could shop on the ACA Marketplace, or 4.7 million people nationwide, are eligible to purchase a bronze plan with $0 premiums after subsidies in 2020.

December 2, 2019 News Release

New Resource Outlines Efforts to Expand Screening and Counseling for Intimate Partner Violence

Two resources give an overview of intimate partner violence (IPV) in the U.S. and insurance coverage for screening and counseling.

December 2, 2019 Issue Brief

HIV, Intimate Partner Violence (IPV), and Women: An Emerging Policy Landscape

Intimate partner violence has been shown to be associated with increased risk for HIV among women, as well as poorer treatment outcomes for those already diagnosed. This brief reviews the link between IPV and HIV, key policy changes and initiatives that attempt to address these challenges.

November 26, 2019 Slideshow

Public Opinion on Single-Payer, National Health Plans, and Expanding Access to Medicare Coverage

November 25, 2019 News Release

Two Medicaid-Related Initiatives That Help Promote Long-Term Care at Home and in the Community, Rather Than in Institutions, Are Set To Expire at the End of December

Two initiatives that for years have helped shift Medicaid enrollees away from nursing homes in favor of long-term care at home and in the community face year-end deadlines that could undercut that trend, according to two new KFF issue briefs. While there does not appear to be substantive disagreement over…

November 25, 2019 Issue Brief

Implications of the Expiration of Medicaid Long-Term Care Spousal Impoverishment Rules for Community Integration

To financially qualify for Medicaid long-term services and supports (LTSS), an individual must have a low income and limited assets. In response to concerns that these rules could leave a spouse without adequate means of support when a married individual needs LTSS, Congress created the spousal impoverishment rules in 1988. Originally, these rules required states to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when determining nursing home financial eligibility, but gave states the option to apply the rules to home and community-based services (HCBS) waivers.
Section 2404 of the Affordable Care Act (ACA) changed the spousal impoverishment rules to treat Medicaid HCBS and institutional care equally from January 2014 through December 2018. Congress subsequently extended Section 2404 through December 2019. This issue brief answers key questions about the spousal impoverishment rules, presents 50-state data from a 2018 Kaiser Family Foundation survey about state policies and future plans in this area, and considers the implications if Congress does not further extend Section 2404.

November 21, 2019 Issue Brief

Insurer Participation on ACA Marketplaces, 2014-2020

Since the Affordable Care Act (ACA) health insurance marketplaces opened in 2014, there have been a number of changes in insurance participation as companies entered and exited states and also changed their footprint within states. This brief and interactive maps show how insurance participation has changed over time in every county in the U.S.

November 20, 2019 News Release

Poll: On Health Care, Democrats and Democratic-Leaning Independents Trust Sen. Sanders the Most, but Significantly More People Support a Public Option than Medicare-for-All

3 in 4 Americans Do Not Expect Congress to Take Action to Lower Drug Costs Before the 2020 Election Ahead of tonight’s Democratic presidential debate, Sen. Bernie Sanders is the candidate most trusted on health care by Democrats and Democratic-leaning independents, though the Medicare-for-all plan he has championed is significantly…

November 20, 2019 Poll Finding

KFF Health Tracking Poll – November 2019: Health Care In The 2020 Election, Medicare-for-all, And The State Of The ACA

This poll examines the issues Democrats most want to hear in the debates, their trust of the Democratic candidates on health care, attitudes towards Medicare-for-all and a public option, perceptions of the Affordable Care Act’s health insurance marketplaces, and prospects of legislation to address prescription drug costs.

November 15, 2019 Issue Brief

From Ballot Initiative to Waivers: What is the Status of Medicaid Expansion in Utah?

The Utah legislature significantly changed and limited the Medicaid coverage expansion that was adopted by the voters through a ballot initiative in November 2018. This issue brief explains new provisions in Utah’s recently amended Section 1115 Medicaid waiver and the additional amendments that the state has submitted to CMS, including most recently a request for enhanced ACA federal matching funds for an expansion to 138% FPL with an enrollment cap.