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  • Private Insurers Expect to Pay $1.1 Billion in Rebates This Year for Setting Premiums Too High Relative to Medical Costs

    News Release

    Private insurance companies are expecting to pay out about $1.1 billion in rebates this fall under an Affordable Care Act (ACA) provision that requires insurers to spend the bulk of customers’ premium payments on care, a new KFF analysis finds. Rebates are based on insurers’ experiences over the previous three years. This year’s estimated total is similar to the $1 billion paid out last year, but well short of the $2.5 billion record total paid…

  • State-Based Efforts Will Provide Limited Relief from Enhanced Tax Credit Expiration

    Policy Watch

    After failed Senate votes late last year and no subsequent bipartisan agreement, the enhanced premium tax credits expired as of January 1. Some states, particularly those operating State-Based Marketplaces (SBMs), have been preparing for this possibility for months and are moving to blunt the impact on consumers by implementing their own state-funded subsidies and implementing other programs aimed at stabilizing the cost of unsubsidized premiums.

  • Constrained Budgets Lead States to Restrict HIV Drug Access Through Ryan White

    Policy Watch

    States are facing constrained budgets, putting pressure on HIV programs, including the Ryan White HIV/AIDS Program. This Policy Watch explores how state Ryan White AIDS Drug Assistance Programs (ADAPs) are responding to these budget pressures, including by restricting eligibility and reducing the scope of services offered, actions that could led to negative health outcomes for people with HIV and lead to new HIV infections.

  • Health Insurer Financial Performance in 2024

    Issue Brief

    This analysis of trends in health insurers’ financial data shows that insurers’ gross margins per enrollee dipped slightly in 2024 across four markets, remaining highest in the Medicare Advantage market, followed by the individual (non-group) market, the fully insured group (employer) market, and Medicaid managed care. The analysis also examines insurers’ medical-loss ratios across the four markets.

  • Marketplace Enrollees with Unpredictable Incomes Could Face Bigger Penalties Under House Reconciliation Bill Provision

    Issue Brief

    This analysis illustrates how provisions included in the House budget reconciliation bill could expose Marketplace enrollees with unpredictable incomes to higher penalties when filing taxes if they underestimate their incomes. About one in four potential Marketplace shoppers had incomes that varied at least 20 percent from the beginning to the end of the year.

  • Calculator: ACA Enhanced Premium Tax Credit

    Feature

    The ACA's enhanced premium tax credits expired at the end of 2025. This calculator estimates how much out-of-pocket premium payments would increase for families without the enhanced credits. The projected premium increases are estimated based on family income, zip code, size, ages, and 2026 ACA Marketplace premiums.

  • How Much and Why ACA Marketplace Premiums Are Going Up in 2026

    Issue Brief

    This analysis of initial rate filings from all 50 states and DC shows ACA Marketplace insurers are proposing a median premium increase of 18% for 2026, more than double last year’s 7% median proposed increase. The analysis includes proposed rate changes by state and insurer.

  • How Accessible is Individual Health Insurance for Consumers in Less-Than Perfect Health?

    Report

    This report documents the findings of a study examining access to health insurance coverage in the individual market for people with health problems. Seven hypothetical consumers with varying health conditions were defined and insurers and HMOs in eight different markets around the country were asked to consider them as though they were real consumers applying for coverage. Renewed debate over proposals to expand coverage for the uninsured using tax credits for the purchase of individual…