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In 2024, ACA enrollment (including Marketplace, Medicaid expansion, and BHP) reached 44 million, or 16.4% of the nonelderly U.S. population. From 2020-2024, enrollment in ACA coverage increased by over 60%.
A new KFF analysis finds that there were 44 million people enrolled in health coverage through the Affordable Care Act’s Marketplaces and its expansion of the Medicaid program in 2024. That represents about 1 in every 6 people under age 65, or 16.4%.
A per capita cap in Medicaid may be a solution in search of a problem. However, if a cap substantially reduced federal Medicaid spending over time, it would put states at financial risk and force cuts to services and rates paid to physicians, hospitals, and nursing homes.
With President-elect Trump returning to the White House and Republicans controlling Congress, significant changes to the Medicaid expansion are expected. This data note provides key facts on the Medicaid expansion, highlighting the financial and coverage impacts of any changes across states that voted for President-elect Trump and those that voted for Vice President Harris.
In his latest column, President and CEO Drew Altman shows how proposals contained in the House reconciliation bill could result in a one-third reduction in ACA Marketplace enrollment. “While all eyes are on the big Medicaid cuts being proposed in the House,” he writes, “significant changes are also being proposed that together would dramatically reduce enrollment in the ACA Marketplaces.”
The interactive maps illustrate how many people are enrolled in Medicare and Medicaid in each congressional district, including the number of people receiving full Medicaid and partial Medicaid benefits.
This analysis examines the potential impacts on states and Medicaid enrollees of implementing a per capita cap on the federal share of Medicaid spending for the ACA Medicaid expansion population only, which is another proposal that has been discussed by members of Congress.
This issue brief examines Medicaid expansion enrollment and Medicaid spending in expansion and non-expansion states and describes the characteristics of adults covered by the Medicaid expansion.
This brief considers how default enrollment into Medicare Advantage might work, potential challenges with this approach, and implications for beneficiaries, insurers, providers, agents and brokers, and the federal budget.
In his latest column, president and CEO Drew Altman discusses why debate about extending the ACA enhanced tax credits set to expire this year has been slow to develop, and why it could matter to Republicans politically if the tax credits are not extended.
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