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The ACA MarketplaceS

What We Know about Trump’s $500 ACA Checks and the User Fees Funding Them

This analysis examines the $500 checks that the Trump administration is sending to some Affordable Care Act Marketplace enrollees and the user fees that are paying for them. The checks are going to about 1 million enrollees in the 30 states that rely on the federal HealthCare.gov Marketplace who are not receiving any tax credits this year.

Individual Market Enrollment Declined by 18% Since June 2025

Individual Market Enrollment Fell 18%, Suggesting Continued ACA Marketplace Losses

Enrollment in the individual health insurance market fell by 18%—over 4.6 million people—from 25.2 million in June 2025 to 20.5 million in June 2026. Falling individual market enrollment suggests further decline in ACA Marketplace enrollment this year, since Marketplace enrollees represent the vast majority of individual market coverage. The enrollment decline coincides with the expiration of the enhanced premium tax credits and other policy changes that are expected to reduce enrollment.

About the ACA

Promotional image for KFF video How Affordable is the Affordable Care Act

Did the Affordable Care Act Make Health Care More Affordable?

The expiration of the ACA’s enhanced premium tax credits at the start of 2026, combined with rising insurer premiums, put a spotlight on health care affordability that extends beyond Marketplace enrollees. KFF’s Cynthia Cox examines the ACA’s record and the broader underlying question it raises: what’s a fair price for Americans people to pay for health care?

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  • Shared Medical Decision Making: We’re in This Together

    Event Date:
    Event

    In recent years, awareness of the patient’s important role in managing his or her own care has been steadily growing—fed not only by such trends as the proliferation of health information on the internet and direct-to-consumer advertising, but also by the emerging science of patient-centered decision making. One way to facilitate shared decision making is through the use of decision support tools, which offer the patient high quality medical information in an easily understandable format.…

  • Mobile Technology: Smart Tools to Increase Participation in Health Coverage

    Issue Brief

    As mobile technology advances and cell phone use continues to increase across demographic groups, there is significant potential to tap these technologies to facilitate enrollment in and retention of health coverage, in both the immediate term and as health reform is implemented. A brief produced in conjunction with The Children's Partnership examines how various tools and strategies, including text messages and smart phone apps, can be used to advance coverage goals. The report focuses especially…

  • Medicaid Matters: Understanding Medicaid’s Role in Our Health Care System

    Fact Sheet

    This fact sheet provides key information about the Medicaid program and its role in our health care system and state economies. The nation’s public health insurance program for low-income people is counter-cyclical, expanding during the recent recession to assist millions of individuals and families affected by the loss of jobs and job-based health insurance. While the program has worked as intended, economic conditions have contributed to growing pressure on state budgets and Medicaid funding. This…

  • Essential Health Benefits: Balancing Affordability and Adequacy

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    Under the Patient Protection and Affordable Care Act (PPACA), insurance plans offered through state insurance exchanges as well as non-grandfathered plans offered in the individual and small group markets - will be required to cover a set of health benefits and services called the "essential health benefits" package. Guidance issued last month by the Department of Health and Human Services will give each state some discretion to specify benefits package raises many questions. What is…

  • Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

    Issue Brief

    Massachusetts is the first state to finalize a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test CMS's capitated financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, with enrollment beginning on April 1, 2013. Starting in 2013, CMS will implement a three-year multi-state demonstration to test new service delivery and payment models for people who are eligible for both federal health programs. Massachusetts' demonstration…

  • The New Review and Approval Process Rule for Section 1115 Medicaid and CHIP Demonstration Waivers

    Fact Sheet

    For many years, Section 1115 waivers have been used in the Medicaid program to provide states an avenue to test and implement coverage approaches that do not meet federal program rules, but there have been longstanding concerns about the lack of public input and transparency in the waiver approval process. As a result, the Affordable Care Act required the Department of Health and Human Services to issue regulations designed to ensure that the public has…

  • The Right Care at the Right Time: Are Retail Clinics Meeting a Need?

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    The Alliance for Health Reform and WellPoint, Inc. discuss the role of urgent care centers and retail clinics emerging within the health care system. Panelists will explore such questions as: Can savings and improved access to care be produced through alternative care settings? Will these settings reduce emergency room use for primary care? Do they have the potential to ease the shortage of primary care providers? Who is monitoring the quality of care being delivered…

  • Making Sense of the Census Uninsured Numbers

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    The Alliance for Health Reform and the Kaiser Family Foundation’s Commission and Medicaid and the Uninsured discuss the Census uninsured numbers. The Census Bureau announced that the number of people without health insurance dropped from 50 million to 48.6 million in 2011, marking the first decrease since 2007. That information came from the Current Population Survey, but it isn't the only data that Census is releasing on the uninsured. The Bureau is preparing a second…

  • How Much Will Medicaid Physician Fees for Primary Care Rise in 2013? Evidence from a 2012 Survey of Medicaid Physician Fees

    Issue Brief

    This brief presents 50-state data from the 2012 KCMU/Urban Institute Medicaid Physician Fee Survey. It estimates that average Medicaid fees to qualified physicians for Affordable Care Act primary care services will rise by 73 percent when the primary care fee increase takes effect on January 1, 2013, although there will be wide state variation. The paper presents data showing how states compare in their 2012 Medicaid fee levels, how Medicaid fees compared to Medicare fees,…

  • Prescription Drug Trends Fact Sheet – May 2010 Update

    Fact Sheet

    This updated fact sheet provides trend information about prescription drug expenditures and coverage, key factors that contribute to rising prescription spending, and efforts to contain rising drug costs. May 2010 Fact Sheet (.pdf)