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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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  • Amid the Coronavirus Crisis, President Trump and Democratic Nominee Joe Biden Offer Widely Different Views on Health Care

    News Release

    President Trump and Democratic nominee Joe Biden hold widely divergent views on health issues, with the president’s record and response to the coronavirus pandemic likely to play a central role in November’s elections. A new KFF side-by-side comparison examines President Trump’s record and former Vice President Biden’s positions across a wide range of key health issues, including the response to the pandemic, the Affordable Care Act marketplace, Medicaid, Medicare, drug prices, reproductive health, HIV, mental…

  • Election 2020: Where Trump and Biden Stand on Mental Health and Substance Use Issues

    News Release

    Amid the coronavirus pandemic, half of Americans report that their mental health has been negatively impacted due to related stress and worry. Many are, or will be, struggling with mental health challenges due to anxiety, social isolation, loss of loved ones, and job losses – potentially leading to increased mental health care needs over the long term. A new issue brief examines where President Trump and Democratic presidential nominee Joe Biden stand on key aspects of the…

  • JAMA Forum: Trump vs Biden on Health Care

    Perspective

    In this September 2020 post for The JAMA Health Forum, Larry Levitt highlights differences in the records and policy plans of President Donald Trump and former Vice President Joe Biden on key health care issues.

  • Get Ready for a Lot of Biden Executive Orders on Health Care

    Perspective

    In this column for the JAMA Health Forum, Larry Levitt explores what President-elect Biden might do to advance his health care vision both through legislation and through executive orders and waivers and demonstrations.

  • Joe Biden’s New Health Care Agenda (and CMS’s Big Role In It)

    From Drew Altman

    With the Georgia runoff elections giving Democrats control of the U.S. Senate, Drew Altman discusses President-elect Biden’s potential health care agenda and suggests that the Centers for Medicare & Medicaid Services could have an expanded role and that it may be time to rename it and elevate it to a cabinet agency.

  • New Kaiser Survey of People with Non-Group Insurance Finds Nearly Six in 10 People Enrolled in Marketplace Plans Were Previously Uninsured

    News Release

    People in ACA-Compliant Plans Are Somewhat More Likely To Say They Are in Fair or Poor Health Than Those in Non-Compliant Plans People Who Switched Plans Due to Cancellation Notices or Other Reasons Are As Likely To Say Their Premiums Went Down As Went Up Overall About As Many People in This Market Feel They Benefited From the ACA As Feel Negatively Impacted, With Variations By Sub-Group The first in a series of new surveys…

  • Data Note: Differences In Public Opinion On The ACA’s Contraceptive Coverage Requirement, By Gender, Religion, And Political Party

    Feature

    One of the most politically polarizing elements of the Affordable Care Act (ACA) is the law’s requirement that new private health insurance plans cover prescription contraceptives and services, including all methods approved by the Food and Drug Administration. The rule currently provides an exemption for houses of worship and an “accommodation” for religiously affiliated non-profit employers who object to providing contraceptive coverage; however all for-profit employers that provide health insurance must include this benefit. Over…

  • Issue Brief Explores Consequences of Potential Supreme Court Decisions on the ACA Contraceptive Coverage Requirement

    News Release

    A new Kaiser Family Foundation issue brief explores some of the factors influencing employers’ coverage decisions and possible consequences for employers and workers that could arise from possible Supreme Court decisions in the cases brought by Hobby Lobby and Conestoga Wood Specialties, for-profit corporations challenging the Affordable Care Act’s requirement to cover contraceptive services and supplies in health insurance. Other resources about the Supreme Court case are also available online.

  • Visualizing Health Policy: Understanding the Effect of Medicaid Expansion Decisions in the South

    Other Post

    This Visualizing Health Policy infographic examines the effect of decisions by states in the South to implement or forgo the Affordable Care Act Medicaid expansion. It shows that Southerners are more likely than people living in other parts of the United States to be uninsured; that most Southern states have poverty rates above the national average; that without the Medicaid expansion (which most Southern states are not implementing), Medicaid eligibility levels for adults in the South remain…