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Affordable Care Act

The ACA MarketplaceS

Tracking Insurer Changes in the ACA Marketplaces in 2027

As of June 22, six carriers have announced that they will exit the Marketplaces in plan year 2027, either in some or all states that they are currently offering plans; four carriers have announced they will enter new Marketplaces.

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

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 triple digits – with the expiration of enhanced tax credits.

POLLING on the ACA

Tracking the Public’s Views on the ACA

While overall opinion of the Affordable Care Act has been more favorable than unfavorable since 2017, there remain deep partisan divides. See how public opinion on the ACA has changed from the inception of the law to the present. This interactive tool highlights key moments when views shifted and trends based on party identification, income, age, gender, and race/ethnicity.

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  • The Texas Health Care Landscape

    Report

    This fact sheet summarizes the Texas health care landscape, including data on demographics, population health, the uninsured and the state Medicaid program. Fact Sheet (.pdf)

  • Insurer Rebates under the Medical Loss Ratio: 2012 Estimates

    Report

    Beginning in 2011, the Affordable Care Act (ACA) requires insurance plans to pay out a minimum percentage of premium dollars towards health care expenses and quality improvement activities, limiting the amount spent on administrative and marketing costs and profit. Under the law, large group plans are required to spend at least 85 percent of premium dollars on health care and quality improvement, while small group plans must spend at least 80 percent. These ratios are…

  • Pulling It Together: Are We Headed for a Government Takeover of Health Care?

    Perspective

    Remember the “government takeover of the health care system” argument that critics of the health reform law have used?  Well, last week the Office of the Actuary in the Centers for Medicare and Medicaid Services published the latest projections of health spending in the journal Health Affairs.  Attention focused mainly on the Actuary’s estimate that national health spending would grow to almost 20% of GDP by 2020 and that the Affordable Care Act (ACA) would…

  • The Coverage and Cost Impacts of Expanding Medicaid

    Report

    This paper quantifies the impacts on coverage and cost of expanding Medicaid to cover more of the low-income uninsured, including adults, at various income levels and with improved participation rates. The analysis models two primary options to expand Medicaid (250% FPL for children, 100% FPL for adults; 300% FPL for children, 150% for adults) as well as the same options with no change for children. Report (.pdf)

  • Rising Health Pressures in an Economic Recession: A 360-Degree Look at Four Communities

    Report

    This report draws on interviews and focus groups in four communities to examine at the grassroots levels the experiences of families, employers, safety-net providers and community organizations in four U.S. communities hard hit by the recession. The communities are Beloit, Wisc.; Tampa-St. Petersburg, Fla.; Long Island, N.Y.; and Sonoma, Calif. The report explores the financial and personal struggles of families who have suffered economic reversals and lost health coverage, forcing many to juggle bills and…

  • Pulling It Together: Predictions

    Perspective

    I usually don’t make predictions, unless they are backed up by the kind of statistical modeling we often produce.  But here are three predictions I am confident about that form the basis of this latest column. GROUP HEALTH INSURANCE PREMIUMS WILL CONTINUE TO RISE AT HISTORICALLY MODERATE LEVELS, AT LEAST FOR THE NEXT FEW YEARS.  One reason for this is the lingering effect of the recession.  Employers will have little trouble attracting workers in the…

  • Explaining Health Reform: The New Rules for Determining Income Under Medicaid in 2014

    Issue Brief

    To provide individuals and families access to affordable, high-quality health care, the Patient Protection and Affordable Care Act (ACA) expands Medicaid to cover low-income adults and children with incomes up to 133 percent of the poverty line. Millions of low-income parents, non-disabled adults who do not have dependent children (and who are generally ineligible for Medicaid today except in a small number of states) and, in some instances, children now covered through the Children’s Health…

  • Pulling It Together: Changing the HIV Testing Message

    Perspective

    In 2006 the CDC began recommending routine HIV testing in health care settings for everyone between the ages of 13 and 64. Annual  testing is recommended for people at highest risk. Our 2011 survey of Americans and HIV released last week -- our eighth comprehensive survey of its kind --  shows that more people are talking with their doctors about being tested for HIV, but that reported rates of actually getting tested have remained virtually…

  • Community Care of North Carolina: Putting Health Reform Ideas into Practice in Medicaid

    Issue Brief

    This policy brief examines the structure and experience of Community Care of North Carolina, an enhanced medical home model of care that North Carolina began implementing in 1998 as part of its Medicaid program. Evaluations of the initiative, which includes a heavy emphasis on care coordination, disease and care management and quality improvement, suggest that it has resulted in both improved care and cost savings. The program provides important lessons for broader health reform efforts…