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Affordable Care Act

The Enhanced Premium Tax Credits

About Half of Adults with ACA Marketplace Coverage are Small Business Owners, Employees, or Self-Employed

About Half of Adults with ACA Marketplace Coverage are Small Business Employees or Self-Employed and Could Face Higher Premiums Soon

About half (48%) of adults with ACA Marketplace coverage are employed by small businesses or are self-employed and could face higher premiums soon. Because the vast majority of individual market coverage is purchased through the Affordable Care Act (ACA) Marketplaces, changes to the ACA, including the expiration of the enhanced premium tax credits at the end of this year, would have significant implications for what small business owners and workers spend on their health care.

New and noteworthy

ACA Marketplace Plans Nationally Are Seeking a Median 18% Premium Increase for 2026

This analysis of insurers’ initial rate filings for Affordable Care Act Marketplace plans in all 50 states and DC finds the median proposed increase for 2026 is 18%, more than double last year’s proposed increase. The analysis also shows proposed rate changes by state and insurer.


Tariffs Are Driving up Premiums for Small Businesses

Estimates of Additional Uninsured People Across the States

ACA Provisions in the 2025 Federal Budget Reconciliation Law

Health Insurance Marketplace Calculator

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  • Medicaid Expansion Spending and Enrollment in Context: An Early Look at CMS Claims Data for 2014

    Issue Brief

    This issue brief analyzes spending and enrollment data made available by CMS through the MBES. It breaks out spending and enrollment for the new adult group (Group VIII) that gained coverage in states that adopted the ACA Medicaid expansion. It looks at spending and enrollment for the new adult group in calendar year 2014, putting such data in the context of overall Medicaid spending and enrollment and examines trends across expansion states.

  • States with Section 1115 ACA Expansion Waivers, December 2015

    Feature

    This slide shows the current status of state decisions to use Section 1115 waivers to expand Medicaid. A total of 31 states including DC have adopted the ACA Medicaid expansion, including 6 states with ACA 1115 ACA expansion waivers. AZ has a pending waiver application that seeks changes to its expansion. MT and NH’s waivers will take effect on 1/1/16. PA originally expanded through a waiver but subsequently transitioned to a state plan amendment. TN and UT have debated waiver proposals which have not been approved by their state legislatures or submitted to CMS.

  • Analysis of Insurer Participation in 2016 Marketplaces

    Issue Brief

    As Marketplace enrollees begin to shop for coverage starting in 2016, the number of insurance choices available to them is changing in some parts of the country.  In early 2015, an average of 6.1 insurer groups offered coverage in each state, up from an average of 5.0 in 2014.

  • The Impact of the Coverage Gap for Adults in States not Expanding Medicaid by Race and Ethnicity

    Issue Brief

    The Affordable Care Act (ACA) expansion of Medicaid to adults with incomes at or below 138% of the federal poverty level (FPL) effectively became a state option following the Supreme Court decision, creating a “coverage gap” for many poor uninsured adults in states that do not expand Medicaid. This brief examines the coverage gap by race and ethnicity.

  • The California Health Care Landscape

    Fact Sheet

    This fact sheet provides an overview of population health, health coverage, and the health care delivery system in California in the era of health reform.

  • The ACA and People with HIV: Profiles from the Field

    Issue Brief

    This brief provides profiles of twelve individuals living with HIV to offer an in-depth look at how the Affordable Care Act (ACA) has affected their healthcare and coverage. Participants live in California, Florida, Georgia, New York, and Texas and discuss their enrollment and coverage experience, including whether they got new coverage (in the Marketplace or Medicaid), how their HIV care has been affected, and the role of the Ryan White HIV/AIDS Program.

  • The ACA and People with HIV: Profiles from the Field

    News Release

    New in-depth profiles of 12 people with HIV highlight how the Affordable Care Act’s coverage expansions impacted their access to coverage and care. While some experienced serious bumps along the way, those who gained coverage through Medicaid and the Marketplaces were largely able to meet both their HIV and non-HIV care needs.

  • The Ryan White Program and Insurance Purchasing in the ACA Era: An Early Look at Five States

    Issue Brief

    This issue brief examines the role that the Ryan White Program has played in helping HIV positive clients purchase insurance coverage from both a historical and an Affordable Care Act (ACA) era perspective. The ACA era analysis focuses on activities in five states during the first open enrollment period and looks specifically at insurance purchasing through the health insurance marketplaces. The states analyzed are California, Florida, Georgia, New York, and Texas.

  • The Health-Care Enrollment Story Is in the States

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman examines the variation among states beneath the national Affordable Care Act’s Marketplace enrollment numbers released by the U.S. Department of Health and Human Services. All previous columns by Drew Altman are available online.