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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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  • Premium Assistance in Medicaid and CHIP: An Overview of Current Options and Implications of the Affordable Care Act

    Issue Brief

    Premium assistance is the use of public funds through Medicaid or the Children’s Health Insurance Program (CHIP) to purchase private coverage. States have pursued premium assistance with varied objectives, including covering parents not otherwise eligible for public coverage and promoting the use of private coverage. Implementation of the Affordable Care Act (ACA) coverage expansions is likely to spark renewed interest in premium assistance options. This brief provides an overview of premium assistance options and examines…

  • Optimizing Medicaid Enrollment: Spotlight on Technology – Louisiana’s Express Lane Eligibility

    Issue Brief

    This piece looks at how Louisiana uses “express lane eligibility" to increase and streamline the enrollment of low-income children in its Medicaid program. It is the first in a Spotlight on Technology series profiling several states' innovative applications of technology to Medicaid enrollment efforts. The series illustrates a range of approaches that states can adopt to improve their systems now and to prepare for the expansion of Medicaid under health reform. Spotlight (.pdf)

  • Expanding Coverage to Adults through Medicaid Under Health Reform: Key Issues to Consider for Implementation

    Issue Brief

    The Kaiser Commission on Medicaid and the Uninsured convened a roundtable discussion on June 23, 2010 with a group of federal and state officials and experts to discuss key issues related to reaching, enrolling and delivering care to adults in Medicaid under health reform. The discussion focused in particular on non-disabled adults without dependent children (often referred to as "childless adults") who have historically been ineligible for the program. When the new coverage goes into…

  • Side-by-Side Comparison of Major Health Care Reform Proposals

    Issue Brief

    On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, and a week later, signed into law the Health Care and Education Reconciliation Act of 2010, which made some changes to the comprehensive health reform law. Summary of Final Health Care Reform Law (.pdf) Download a printable comparison of the new health reform law (the Patient Protection and Affordable Care Act), the House-passed Health Care and Education Reconciliation Act…

  • Dissatisfaction with Health Insurance Despite Positive Ratings

    Perspective

    Personal experiences with the health care system are a key factor in Americans’ opinions on how the health care system should function and their expectations of how the Affordable Care Act (ACA) will change the system when fully implemented. In order to take a closer look at these personal experiences, this post explores findings from the March Kaiser Health Tracking Poll on Americans’ views of their health care and coverage, including health insurance ratings and…

  • Kaiser Polling Data Note Finds Regional Differences in Views of Health Reform Law

    Perspective

    Based on the November Kaiser Health Tracking Poll, the latest KFF data note examines regional differences in Americans’ views of the new health reform law. Although many states in the American South and West stand to be disproportionately eligible for federal funds under the new law, the analysis finds that opinions of the law play out quite differently in these regions. Those living in the Western and Northeastern United States are more likely to view…

  • Non-Voters and Health Reform: Indifference and Confusion Over the New Law

    Perspective

    The latest Kaiser Health Tracking Poll assessed the role health reform played in voters’1 decisions in the midterm elections and the public’s overall mood towards the health reform law. This blog post focuses on a different group, people who say they are not registered or did not vote in last week’s election, and examines how their views on the health reform law differ from those that said they did vote. As is usually the case,…

  • Kaiser November Tracking Poll Finds Health Care a Factor in Congressional Election, But Not a Dominant One

    Perspective

    This month’s Kaiser Health Tracking Poll, conducted during the four days following the mid-term election, asked voters in an open-ended question to name in their own words the biggest factors influencing their vote for Congress, and found that health care was a factor, but not a dominant one. Among all voters, the factor mentioned most often was the economy/jobs (29%). The next two most mentioned factors were party preference (25%) and views of the candidates…