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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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  • Why Drug Price Negotiation Has Staying Power

    From Drew Altman

    In this Axios column, Drew Altman looks beyond Medicare to what’s at stake for employers and workers in the debate about the government negotiating drug prices.

  • How Marketplace Costs and Premiums will Change if Rescue Plan Subsidies Expire

    Policy Watch

    In this Policy Watch we explore the potential impact of the expiration of the American Rescue Plan Act’s enhanced financial help and new eligibility for the Affordable Care Act’s health insurance Marketplace federal subsidies. While the COVID-19 relief legislation passed earlier this year provides greater subsidy assistance through 2022, Democrats in Congress are currently considering making the temporary federal help permanent or extending it as part of their planned budget reconciliation legislation.

  • Escuché que hay una nueva oportunidad de inscripción especial para las personas de muy bajos ingresos. ¿Cómo funciona?

    FAQs

    Desde el 25 de agosto de 2025, se eliminó la oportunidad de inscripción especial que permitía a las personas con ingresos iguales o inferiores al 150% del nivel federal de pobreza inscribirse en la cobertura del mercado de seguros durante todo el año, simplemente por sus bajos ingresos. Las personas con este nivel de ingresos aún podrían calificar para la inscripción especial en otros eventos de inscripción especial, como cuando pierden la cobertura por pérdida…

  • More Than 6 in 10 of the Remaining 27.4 Million Uninsured People in the U.S. are Eligible for Subsidized ACA Marketplace Coverage, Medicaid or the Children’s Health Insurance Program

    News Release

    Recent policy attention has focused on efforts to reduce the number of uninsured people in the U.S. by expanding eligibility for coverage assistance, including enhanced premium subsidies in the Affordable Care Act (ACA) Marketplace and filling the Medicaid “coverage gap.” A new KFF analysis shows that a majority of the 27.4 million people who remained uninsured in 2020 already are eligible for financial assistance for coverage through Medicaid/CHIP or the Marketplace, suggesting that policies in…

  • The Affordable Care Act 101

    Feature

    This Health Policy 101 chapter provides an overview of the Affordable Care Act (ACA), a major reform of the U.S. health care system aimed at reducing high uninsured rates and alleviating issues like high out-of-pocket costs and coverage exclusions for preexisting conditions. The ACA significantly altered many aspects of the health system and the chapter explores its mechanisms, such as the Health Insurance Marketplaces, and the evolution of the law since its passage in 2010…

  • Prior Authorization Metrics Provide New Insights into Insurer Practices, but Gaps Remain

    Issue Brief

    This analysis of available 2025 prior authorization data finds insurers denied at least 1 in 8 standard requests for prior authorization across three insurance markets: Medicare Advantage, Medicaid managed care, and the federally facilitated ACA Marketplaces. Denial rates varied wide segments by insurer. The analysis highlights limitations of the data and challenges for consumers interpreting it.

  • Claims Denials and Appeals in ACA Marketplace Plans in 2024

    Issue Brief

    This brief analyzes federal transparency data published by CMS on claims denials and appeals for Marketplace plan offered on HealthCare.gov in 2024, and finds insurers denied 19% of in-network claims. Consumers rarely appeal denied claims.

  • Trump Has No Health Plan, He Has the Art of the Health Care Deal

    From Drew Altman

    In his first column for the new year, KFF CEO Dr. Drew Altman analyzes President Trump’s “make a deal” approach to health care. He explains that while the president doesn’t have a health reform plan, or even “concepts of a plan,” or a replacement for the ACA, he does have a distinctive set of tactics that features one-off deals with the health care industry that are more like “health policy by transaction.” He writes that…