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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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  • ANALYSIS: More than Half of Uninsured People Eligible for Marketplace Insurance Could Pay Less for Health Plan than Individual Mandate Penalty

    News Release

    A new Kaiser Family Foundation analysis finds that more than half (54% or 5.9 million) of the 10.7 million people who are uninsured and eligible to purchase an Affordable Care Act marketplace plan in 2018 could pay less in premiums for health insurance than they would owe as an individual mandate tax penalty for lacking coverage.

  • How the Elections Could Put the Brakes on Anti-ACA Plans

    From Drew Altman

    In this Axios column, Drew Altman examines the role of health care in Virginia's elections and the referendum on Medicaid expansion in Maine. His assessment: the elections and the referendum will have a bigger impact on upcoming policy debates about cutting Medicaid to pay for tax cuts, and state interest in Medicaid expansion, than on upcoming elections. 

  • 2018 Renewal Notices – What Marketplace Consumers Need to Know

    Issue Brief

    As Open Enrollment for 2018 coverage gets underway, consumers who have health coverage through the Affordable Care Act (ACA) Marketplace are again receiving renewal notices from their health insurers. Though the insurer renewal notices this year are based on the same model notice required in the past, this year for many consumers, it may be causing significant – and misleading – sticker shock. That is because renewal notices sent by insurers are required to inform…

  • Kaiser Health Tracking Poll – November 2017: The Politics of Health Insurance Coverage, ACA Open Enrollment

    Feature

    This month marks the start of the ACA's fifth open enrollment period and finds three in ten of the public saying they haven't heard anything at all about the current open enrollment period. Despite their overall views of the ACA, the majority of the public (61 percent) – including most Democrats (71 percent), independents (58 percent), and half of Republicans (52 percent) – say that because President Trump and Republicans in Congress are now in…

  • JAMA Forum: The Health Care Law that Continues to Escape Death

    Perspective

    In this November 2017 post for The JAMA Forum, Larry Levitt reviews the status of the Affordable Care Act following actions by the Trump administration widely perceived as designed to undermine the marketplaces. Despite assertions to the contrary, Levitt finds, "at least for now, the ACA seems very much alive."

  • ACA Mandate Repeal May Be Less Popular Than GOP Thinks

    From Drew Altman

    In this Axios column, Drew Altman discusses how public opinion seems to flip on eliminating the individual mandate as part of the tax legislation, from for it to against, when the public considers the consequences.

  • Kaiser Health Tracking Poll – May 2017: The AHCA’s Proposed Changes to Health Care

    Report

    With House Republicans passing the American Health Care Act (AHCA), their plan to repeal and replace the Affordable Care Act (ACA), and the Senate currently debating the plan and discussing their own approach, the latest tracking poll finds more view the ACA favorably than view the AHCA favorably. The poll examines attitudes towards specific provisions included in the replacement plan and how the public thinks the replacement plan will affect their own health care.

  • The Other Implication of the CBO Report: Election-Year Pain

    From Drew Altman

    In this Axios column, Drew Altman lays out how the “political pain” from the American Health Care Act would play out over the next two election cycles if passed in its current form, based on the Congressional Budget Office’s analysis of the House-passed bill.