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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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  • No Easy Choices: 5 Options to Respond to Per Capita Caps

    Issue Brief

    Under a per capita cap, per enrollee spending would be capped, but the total amount of federal dollars to states could vary with enrollment changes and states would not be able to impose enrollment caps. Faced with restrictions in federal financing, states would have to make hard choices. This brief outlines the key measures states could use to manage their budgets and the associated challenges under a per capita cap: raise taxes or make other…

  • The Great Medicaid Divide

    From Drew Altman

    In his Axios column, Drew Altman examines how the core views Republicans have about Medicaid differ from those of Democrats and Independents, and how those views drive the policy changes they are proposing for the program.

  • Now Available: Summary of Senate Repeal/Replace Bill in 17 Key Areas

    News Release

    An interactive tool from the Kaiser Family Foundation now includes a detailed summary of the Senate’s new discussion draft, the Better Care Reconciliation Act, a plan released Thursday to repeal and replace the Affordable Care Act (ACA). With the tool, users can compare the Senate bill to current law and the House-passed American Health Care Act in 17 key areas of health policy, including Medicaid, premium subsidies to individuals, state role, financing, women’s health, and…

  • The Republican Base is Getting Less Excited About Health Care

    From Drew Altman

    In this Axios column, Drew Altman explains that as Republican policymakers are focused on delivering a repeal of Obamacare for their base, polling shows that it’s not a top priority for Trump supporters, and their intensity on a replacement plan has declined, suggesting that the issue may not drive turnout for future elections.

  • Medicaid’s Role in West Virginia

    Fact Sheet

    This fact sheet provides data on Medicaid's role in West Virginia. It describes how ending the enhanced match for Medicaid expansion and implementing a per capita cap or block grant would affect West Virginia.

  • Medicaid’s Role in Alaska

    Fact Sheet

    This fact sheet provides data on Medicaid's role in Alaska. It describes how ending the enhanced match for Medicaid expansion and implementing a per capita cap or block grant would affect Alaska.

  • Medicaid’s Role in Colorado

    Fact Sheet

    This fact sheet provides data on Medicaid's role in Colorado. It describes how ending the enhanced match for Medicaid expansion and implementing a per capita cap or block grant would affect Colorado.