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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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  • Briefing, Survey Examine 2012 Data From 50-State Survey of Medicaid and CHIP Eligibility and Enrollment Policies

    Event Date:
    Event

    Despite continued tight state budgets, a requirement in the Affordable Care Act (ACA) that states maintain eligibility in Medicaid and Children’s Health Insurance Programs was central in preserving coverage during 2011. In addition, more than half of states (29) made improvements in their programs, often using technology to increase program efficiency and streamline enrollment. These and other findings appear in the Kaiser Commission on Medicaid and the Uninsured report, "Performing Under Pressure: Annual Findings of…

  • Quality Care for Less Money: Can Regional Successes Go National?

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    Event

    On February 15, the Kaiser Family Foundation hosted an event featuring a PBS documentary with former Washington Post correspondent T.R. Reid – U.S. Health Care: The Good News – which explores efforts to provide low-cost, quality health care in the U.S. The film looks at variations in health spending across the country and showcases efficient health care delivery systems, like Grand Junction in Colorado and Group Health in Seattle, suggesting that these communities demonstrate that…

  • The Health Reform Law’s Medicaid Expansion: A Guide to the Supreme Court Arguments

    Issue Brief

    One significant element of the pending U.S. Supreme Court case challenging the Affordable Care Act is the constitutionality of the law's Medicaid expansion. This provision of the law requires states that choose to participate in the Medicaid program to cover nearly all adults under age 65 with household incomes at or below 133% of the federal poverty level as of January 2014. A ruling on the Medicaid expansion could have far-reaching impacts on the present…

  • The Part D Experience: What are the Lessons for Broader Medicare Reform?

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    Event

    Launched in 2006, Medicare added a prescription drug benefit that relies entirely on private plans, while, for other benefits, beneficiaries have a choice between private health plans and traditional fee-for-service Medicare. As policymakers consider changes to Medicare that would give an even greater role to private health plans in caring for Medicare’s nearly 50 million seniors and people with disabilities, the Kaiser Family Foundation hosted a policy workshop to examine how the Part D experience…

  • A Guide to the Supreme Court’s Affordable Care Act Decision

    Issue Brief

    This policy brief describes the Supreme Court's decision on the Affordable Care Act and looks ahead to the implementation of health reform now that questions about the constitutionality of the law have been resolved. Brief (.pdf)

  • Health Insurance Exchanges: Can States and the Federal Government Meet the Deadline?

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    Event

    The Alliance for Health Reform and the Commonwealth Fund sponsor a July 27 briefing to discuss how states are facing implementation and evaluation deadlines in regards to health insurance exchanges. Speakers will explore such questions as: What needs to happen between now and January 2014 for states to successfully implement exchanges and other aspects of health reform? What are options for states if they fail to meet the upcoming November deadline for declaring their exchange…

  • Health Insurance Market Reforms: Pre-Existing Condition Exclusions

    Fact Sheet

    Insurers pursue multiple strategies to reduce the cost of covering enrollees with pre-existing conditions, or medical conditions and health problems that existed before the individual enrolled in a health plan. One strategy, the pre-existing condition exclusion, allows insurers to refuse to cover any costs associated with care for a pre-existing condition permanently or over a period of time. Beginning January 1, 2014, insurers in the individual and group markets will be prohibited from imposing pre-existing…

  • Quick Take: An Update on the ACA & HIV: Medicaid Health Homes

    Fact Sheet

    We recently wrote about the different ways in which the Affordable Care Act (ACA) changes pathways to health insurance coverage for people with HIV, and chronicled these specifics, as well as several outstanding questions, in a policy brief.  As we noted, among the many provisions of the ACA designed to improve care is a new option available to state Medicaid programs to provide “health homes” for Medicaid enrollees with chronic conditions, with a temporary enhanced…

  • Health Care Affordability and the Uninsured

    Event

    Diane Rowland testified at a hearing on the instability of health coverage before the Health Subcommittee of the U.S. House Committee on Ways and Means. Her testimony discussed the growing share of Americans who are uninsured and without adequate health insurance coverage and highlighted the key characteristics and issues with regard to the uninsured as well as the financial burdens for medical care faced by America's families. Testimony (.pdf)