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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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  • How Unaffordable is Health Care? 

    Video

    Health care affordability is a top issue for many people. Why and how did care get so expensive? In this three-part video series, KFF experts look at the rising cost of health care in the U.S. from the macro level to the issues facing everyday Americans. Drawing on KFF policy analysis and polling, the videos examine the underlying drivers of health care spending, the true cost of employer sponsored health insurance and whether the Affordable…

  • Promotional image for KFF video Health Care Unaffordability at the Macro Level

    Health Care Costs Keep Rising … Why and Who Pays?

    Video

    The U.S. spends more on health care than other large, wealthy countries. Concerns about rising costs aren't new, yet somehow we keep paying the bill. In this video, KFF’s Larry Levitt explains how we got here, who bears the consequences and why reining in spending systematically may be central to the next big health care debate.

  • Promotional image for KFF video How Affordable is the Affordable Care Act

    Did the Affordable Care Act Make Health Care More Affordable?

    Video

    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?

  • In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

    News Release

    ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

  • An image of text is an excerpt from Cynthia Cox's quick take which reads, "While the Trump administration attributes this drop in enrollment to their attempts to address fraud, this coverage loss happened at the same time millions of people faced steep increases in their premium payments — often in the double or even triple digits — with the expiration of enhanced tax credits."

    ACA Marketplace Enrollment Is Down By 3 Million After Big Jump in Premium Payments

    Quick Insights

    Enrollment dropped 13% following the expiration of enhanced premium tax credits at the beginning of this year. Enrollment fell from a high of 22.1 million people in 2025 to 19.2 million people in February 2026. While the Trump administration attributes this drop in enrollment to their attempts to address fraud, this coverage loss happened at the same time millions of people faced steep increases in their premium payments – often in the double or even…

  • Key Facts about the Uninsured Population

    Issue Brief

    The number and share of people without insurance grew in 2024, increasing for the first time since 2019, according to KFF's analysis of data from the American Community Survey (ACS). This issue brief describes trends in health coverage in 2024, examines the characteristics of the uninsured population , and summarizes the access and financial implications of not having coverage.

  • An image of text is an excerpt from Jennifer Tolbert's quick take which reads, "While a temporary period of allowing people to self-attest to their compliance with work requirements will ease the effects for some, the more restrictive definition of medical frailty adopted by the Trump Administration will be challenging for states to implement and could lead to more people falling through the cracks and losing coverage."

    CMS Requires More Restrictive Definition of Medical Frailty in New Medicaid Work Requirements Rule

    Quick Insights

    On June 1, 2026, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule on Medicaid work requirements that adopts a restrictive definition of medical frailty—differing from states’ early expectations. The more restrictive definition of medical frailty adopted by the Trump Administration will be challenging for states to implement and could lead to more people falling through the cracks and losing coverage.