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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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  • Ensuring Access to Care in Medicaid Under Health Reform

    Issue Brief

    This paper examines the key issues raised in a December 2010 roundtable discussion of federal and state officials and experts convened by the Kaiser Commission on Medicaid and the Uninsured to examine important issues related to ensuring access to care in Medicaid under the Patient Protection and Affordable Care Act (ACA). The ACA expands Medicaid to reach millions of low-income uninsured Americans and, recognizing current serious access problems system-wide, takes significant steps to build capacity…

  • Explaining Health Reform: The New Rules for Determining Income Under Medicaid in 2014

    Issue Brief

    To provide individuals and families access to affordable, high-quality health care, the Patient Protection and Affordable Care Act (ACA) expands Medicaid to cover low-income adults and children with incomes up to 133 percent of the poverty line. Millions of low-income parents, non-disabled adults who do not have dependent children (and who are generally ineligible for Medicaid today except in a small number of states) and, in some instances, children now covered through the Children’s Health…

  • Affordable Care Act Provisions Relating to the Care of Dually Eligible Medicare and Medicaid Beneficiaries

    Issue Brief

    This issue brief identifies the major provisions in the Patient Protection and Affordable Care Act (ACA) that are designed to improve care and streamline service delivery for dual eligibles, the millions of low-income seniors and younger persons with disabilities who are enrolled in both the Medicaid and Medicare programs. Dual eligibles are among the sickest and poorest individuals covered by either the Medicaid or Medicare programs; they comprise only 15 percent of total Medicaid enrollment…

  • Preventing Chronic Disease: The New Public Health

    Event Date:
    Event

    There is a groundswell of activity in local communities to support healthier lifestyles and help people make long-lasting and sustainable changes that can reduce their risk for chronic diseases. A number of provisions in the health reform law are aimed directly at improving population health by addressing conditions where Americans live, learn, work, and play. Public health agencies across the nation are involved in promoting healthy life styles in their communities and the U.S. Department…

  • Online Applications For Medicaid And/Or CHIP: An Overview of Current Capabilities And Opportunities For Improvement

    Issue Brief

    This analysis provides an overview of online applications for Medicaid and/or CHIP and examines the extent to which they incorporate features that streamline and simplify the enrollment process for individuals. Thirty-two states currently offer an online application for one or both of these programs that is accessible by the public and can be electronically submitted, although they vary in their features. A key component of the Patient Protection and Affordable Care Act is the creation…

  • Pulling It Together: Changing the HIV Testing Message

    Perspective

    In 2006 the CDC began recommending routine HIV testing in health care settings for everyone between the ages of 13 and 64. Annual  testing is recommended for people at highest risk. Our 2011 survey of Americans and HIV released last week -- our eighth comprehensive survey of its kind --  shows that more people are talking with their doctors about being tested for HIV, but that reported rates of actually getting tested have remained virtually…

  • Pulling It Together: Writing Regulations

    Perspective

    Not since Geraldo Rivera revealed the secret contents of Al Capone's vault on national TV in the mid-80s, or more recently, sports fans awaited the LeBron James "decision" about where he would play next, have we so anxiously awaited anything as much as the draft health exchange regulations just published by HHS. Well, okay, I exaggerate for effect, but the regulations on health insurance exchanges were anxiously awaited by the health policy community. The hallmark…

  • How Is The Primary Care Safety Net Faring in Massachusetts? Community Health Centers In The Midst of Health Reform

    Report

    This report examines how community health centers, which provide comprehensive primary care for low-income and uninsured patients, have fared under Massachusetts' health reform law. Community health centers saw a significant increase in patient load amid the state's efforts to improve health coverage by expanding public programs and making private insurance more affordable. That experience shows that community health centers play a critical role in caring for newly insured patients while continuing to serve as the…

  • The Public and the Health Care Delivery System — Summary and Chartpack

    Poll Finding

    This summary and chartpack of the results of a survey by NPR and researchers at the Kaiser Family Foundation and the Harvard School of Public Health highlight the public's attitudes and experiences with the American health care delivery system. The new survey sheds light on Americans' experiences with issues more typically discussed by health policy experts –- including electronic medical records, coordination of care and comparative effectiveness –- all of which have become serious components…

  • April 2009 Health Tracking Poll

    Poll Finding

    The April Kaiser Health Tracking Poll finds that six in ten Americans continues to say that they or a member of their household have delayed or skipped health care in the past year. A solid majority of the public believes health care reform is more important than ever because of current economic problems. The country’s overall economic problems have not dampened their interest in pursuing health care reform: a solid majority of the public (59%)…