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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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  • California's "Bridge to Reform" Medicaid Demonstration Waiver

    Fact Sheet

    This issue brief provides an overview of California's "Bridge to Reform" Medicaid Demonstration Waiver, which was approved in 2010 and will make up to roughly $8 billion in federal Medicaid matching funds available to California over a five-year period to expand coverage to low-income uninsured adults and preserve and improve the county-based safety-net. The waiver also allows the state to enroll Medicaid-eligible seniors and persons with disabilities into managed care plans that meet specified readiness…

  • Health Coverage for the Unemployed

    Issue Brief

    This policy brief outlines the challenges facing the unemployed as they seek to remain insured after losing jobs and employer-sponsored health coverage. In May 2011, 13.9 million people in the U.S. were unemployed. Of these, 6.2 million had been unemployed for six months or more and faced limited options to remain insured. The brief examines potential sources of insurance, including through a spouse's plan, COBRA, the non-group insurance market and public programs. It also discusses…

  • Health Insurance Exchange Development: Innovation in the States

    Event Date:
    Event

    Under health reform, state-based health insurance exchanges are a mechanism to buy private insurance beginning in 2014. Through panel discussions with state leaders and stakeholders, this briefing, jointly sponsored by the Bipartisan Policy Center (BPC), the Kaiser Family Foundation and the University of Virginia's Batten School of Leadership, explored states’ progress on the exchanges and identified next steps. Agenda (.pdf) Speaker Biographies (.pdf)

  • Story Ideas: Impact of the Supreme Court Decision on Health Reform

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    Event

    The Alliance for Health Reform and the Robert Wood Johnson Foundation sponsored this reporters-only briefing to help journalists assess the Supreme Court's decision about the Patient Protection and Affordable Care Act. Full version: Video   Speakers for this session: The panel was moderated by Ed Howard of the Alliance. John R. Lumpkin, Senior Vice President and Director, Health Care Group, Robert Wood Johnson Foundation Alan Weil, National Academy for State Health Policy Michael Cannon, Cato Institute…

  • Oral Health: Putting Teeth into the Health Care System

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    Event

    The Alliance for Health Reform and the Robert Wood Johnson Foundation sponsored an August 17 briefing to discuss oral health coverage under the Patient Protection and Affordable Care Act (PPACA). While PPACA ensures dental coverage for children, challenges remain to improve dental health access and coverage for adults. Speakers will explore such questions as: With 15 percent of the U.S. population living in dental “Health Professional Shortage Areas,” how can dental workforce shortages be addressed?…

  • Medicaid Coverage and Care for the Homeless Population: Key Lessons to Consider for the 2014 Medicaid Expansion

    Report

    Beginning in 2014, the Affordable Care Act ACA provides for a significant Medicaid expansion uninsured, low-income adults. Given their low incomes and high uninsured rate, individuals experiencing homelessness could significantly benefit from this expansion. However, it will be important to address the barriers they face to enrolling in coverage and accessing needed care. This report, based on eight focus group discussions with administrators and frontline workers serving the homeless population in four cities, identifies enrollment…

  • 2008 Presidential Candidates: Health Care Issues Side-by-Side

    Other Post

    Health care has been an important issue in the 2008 presidential campaign and the candidates have staked out positions on key health care issues. Both major party candidates have developed comprehensive health care reform proposals addressing health coverage and access, rising health care costs and health care quality. The side-by-side comparison available here focuses on important health care issues not necessarily addressed in the candidates' health care reform proposals. It was prepared by the Kaiser…

  • Washington’s Managed FFS Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

    Issue Brief

    Washington is the first state to sign a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test a managed fee-for-service (FFS) financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, beginning on April 1, 2013. Washington’s managed FFS demonstration uses Medicaid health home services to coordinate care for high risk/high cost dual eligible beneficiaries with chronic conditions. This policy brief summarizes key aspects of the…

  • What’s Next for the Affordable Care Act?

    Event Date:
    Event

    Health coverage enrollment through the ACA marketplaces now exceeds 24 million people, a dramatic increase in recent years fueled largely by enhanced premium aid. With the subsidies set to expire at the end of this year, Congress and the Trump Administration will be faced with a choice of whether and how to extend the subsidies, alongside broader discussion about the budget. On February 10, KFF’s Larry Levitt moderated a 45-minute virtual discussion with an expert…

  • Health Care Inflation in the U.S.

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    The pressures of inflation are far reaching, affecting providers, insurers, government programs such as Medicaid and Medicare, and, ultimately, the American people. Over the coming months, health care providers and insurers will wrap up pricing negotiations and set premiums for the next year. Amid these negotiations, there remain big questions as to how economic policy and legislation such as the Inflation Reduction Act will influence pricing and payment for insurance and health care, including prescription…