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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

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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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  • Uncompensated Hospital Care Fell by $6 Billion Nationally in 2014, Primarily in Medicaid Expansion States; However Many Hospitals Worry About Future Changes in Medicaid Supplemental Payments

    News Release

    The Affordable Care Act’s coverage expansions have benefited hospitals financially, helping to produce an overall decline nationwide in uncompensated care from $34.9 billion to $28.9 billion in 2014, according to a new analysis by the Kaiser Family Foundation. Nearly all of the decline occurred in Medicaid expansion states, where uncompensated care costs were $10.8 billion in 2014 – down $5.7 billion, or 35 percent, from 2013, the year before ACA coverage expansions took full effect. The…

  • Proposed Changes to Medicaid Expansion in Kentucky

    Fact Sheet

    On June 22, 2016, Governor Bevin released his proposed Section 1115 demonstration waiver application called Kentucky HEALTH (Helping to Engage and Achieve Long Term Health) as an alternative to the current Medicaid expansion which is being implemented through a state plan amendment according to the terms in the ACA. On July 3, 2017, Kentucky submitted an amendment, proposing several changes, to its pending waiver application to the new Administration. This fact sheet summarizes the proposed…

  • Tracking Section 1332 State Innovation Waivers

    Fact Sheet

    This interactive map shows the status of all Section 1332 waivers requested by states. The Affordable Care Act (ACA) allows states to apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets and can be used to shore up fragile insurance markets, address unique state insurance market issues, or experiment with alternative models of providing coverage to state residents.

  • Medicaid’s Role in Ohio

    Fact Sheet

    This fact sheet provides data on Medicaid's role in Ohio. It describes how ending the enhanced match for Medicaid expansion and implementing a per capita cap or block grant would affect Ohio.

  • Poll: Half of the Public Would Blame the Trump Administration if Fewer People Enroll in Marketplace Plans This Year, and Most See President Trump and Republicans As Responsible for the ACA‘s Future 

    News Release

    Majorities of Democrats, Independents and Republicans Would Support Allowing People Younger Than Age 65 to Buy into Medicare Half (50%) of the public would say that if fewer people sign up for marketplace plans during this year’s open enrollment, it is mainly due to the Trump Administration, and most Americans (61%) see President Trump and Republicans as responsible for the Affordable Care Act’s future, the latest Kaiser Family Foundation poll finds. While the public generally…

  • Kaiser Health Tracking Poll – September 2017: What’s Next for Health Care?

    Feature

    This poll finds large majorities across all parties say reauthorizing funding for the Children's Health Insurance Program (CHIP) is an important priority for Congress; however, a larger share of Republicans also say it is important for Congress to work on repealing and replacing the Affordable Care Act (also known as Obamacare). This month's Kaiser Health Tracking Poll also examines public support for a variety of competing health care policies aimed at improving or replacing the…

  • How Affordable Care Act Repeal and Replace Plans Might Shift Health Insurance Tax Credits

    Issue Brief

    The Affordable Care Act, also known as Obamacare, and leading replacement proposals rely on refundable tax credits to help individual market enrollees pay for premiums, although the credit amounts are set quite differently. This analysis compares estimates of an average 2020 tax credit amount under the ACA with averages under the House Republicans' American Health Care Act, introduced March 6, 2017.

  • Medicaid Restructuring Under the American Health Care Act and Implications for Behavioral Health Care in the US

    Issue Brief

    This brief outlines Medicaid’s role for people with behavioral health conditions and the implications of the American Health Care Act for these enrollees. It includes information on the potential impact of ending the enhanced federal financing for newly eligible adults, removing essential health benefits from state plan amendments, and converting federal Medicaid funding into a per capita cap.