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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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  • Medicaid Beneficiaries and Access to Care

    Fact Sheet

    The health reform law relies on a large expansion of Medicaid to reach many low-income uninsured people, many of them adults. This fact sheet summarizes Medicaid beneficiaries' experience in obtaining access to care, a subject that is of keen interest in view of the planned expansion of the program. Medicaid and the Children's Health Insurance Program have substantially increased coverage among low-income Americans, especially children. Research shows that Medicaid compares favorably with private coverage in…

  • Getting the Most Bang for Our Health Reform Buck: Enrolling and Retaining Everyone Who’s Eligible

    Event Date:
    Event

    As Congress looks for ways to increase access to health care, existing programs such as Medicaid and the Children's Health Insurance Program are often overlooked. Yet enrolling those who are eligible for such programs is one of the easiest ways to expand coverage. This briefing, co-sponsored by Alliance for Health Reform and the Pharmaceutical Research and Manufacturers of America (PhRMA), looked at ways to streamline recruitment and enrollment, while exploring how expanding Medicaid and CHIP…

  • Pulling It Together: The Repeal Trap?

    Perspective

    Almost a year into an often acrimonious health reform debate, we stand poised for near certain passage of historic health reform legislation. Yet, somewhat perplexingly, there's now talk about whether a law that has not even been enacted might actually be repealed and reporters have been calling asking what the chances of repeal may be. I have a very hard time imagining any scenario for repeal unfolding. Calls for repeal have much to do with…

  • Optimizing Medicaid Enrollment: Perspectives on Strengthening Medicaid’s Reach Under Health Care Reform

    Issue Brief

    The health reform law creates a national plan for near-universal health coverage that relies on a large expansion of Medicaid eligibility as its foundation. This brief draws on recent interviews with Medicaid program directors and other experts about the opportunities that health reform presents to optimize Medicaid by strengthening its enrollment and renewal operations and recasting it as an affordable health coverage program for working people and families. Executive Summary (.pdf) Issue Brief (.pdf)

  • What’s in There? The New Health Reform Law and Medicare

    Event Date:
    Event

    As part of an ongoing series to explore what is in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, this May 7 briefing sponsored by the Alliance for Health Reform and the Kaiser Family Foundation examines how the reform law affects Medicare. Changes to Medicare were among the most hotly debated issues as the legislation was developed, and this briefing includes a detailed look at the…

  • Liking the Pieces, Not the Package: Contradictions in Public Opinion During Health Reform

    Poll Finding

    Public opinion played a prominent role during the recent health care reform debate. In a published Health Affairs article, Kaiser researchers examine past and present polling and show that opinion tracked with historic patterns and was relatively stable, even if the contentious public debate suggested a volatile public mood in 2009 and 2010. Going forward, the public will begin reacting to reform implementation, primarily by judging it in terms of their perceptions of and experiences…

  • Wisconsin’s BadgerCare Plus Program: Moving Forward on Health Reform Amid a Recession

    Fact Sheet

    This fact sheet provides a brief overview of Wisconsin's BadgerCare Plus Program, a three-year-old initiative that merged the state's three distinct Medicaid programs for children, parents and pregnant women into a single comprehensive health coverage program. It also expanded eligibility to provide near-universal coverage for children and greater coverage for parents and childless adults. As of April 2010, the program provided coverage to 770,000 state residents, including 445,000 children. Fact Sheet (.pdf)

  • A Challenge for States: Assuring Timely Access to Optimal Long-Term Services and Supports in the Community

    Issue Brief

    The Medicaid program is a major payer for long-term services and supports (LTSS) in the United States, accounting for 40 percent of total spending for long-term services and supports. The federal government has played an active role in sponsoring initiatives to promote a shift to community-based care; and evidence from several states suggests that providing care in the community can be less expensive than providing institutional care. The Affordable Care Act (ACA) provides incentives for…

  • The Independent Payment Advisory Board: A New Approach to Controlling Medicare Spending

    Issue Brief

    In 2010, the Patient Protection and Affordable Care Act authorized the creation of the Independent Payment Advisory Board (IPAB) to help control the growth in Medicare costs. Beginning in 2014, IPAB will issue recommendations to lower Medicare costs in the event that spending exceeds targets established in the health care reform law. This brief explains how the Independent Payment Advisory Board will be structured, the process and timelines for IPAB to make recommendations to achieve…

  • Explaining Health Reform: Uses of Express Lane Strategies to Promote Participation in Coverage

    Issue Brief

    Under the Patient Protection and Affordable Care Act (ACA), millions of uninsured adults and children will gain eligibility for Medicaid or health coverage through new health insurance Exchanges beginning in 2014. The law calls upon states to develop simple and streamlined processes for establishing, verifying, and updating eligibility for Medicaid, the Children's Health Insurance Program and federal subsidies for Exchange coverage. This issue brief examines how states can employ "express lane" principles in designing systems…