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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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  • After 16 Years, Partisans Still View the Affordable Care Act Very Differently

    Quick Insights

    On the 16th anniversary of the Affordable Care Act’s (ACA) passage, most of the public (61%) view the law favorably, though opinions and debates remain as partisan as ever....As voters continue to grapple with the affordability of coverage and care, the partisan legacy of the ACA will almost certainly figure into debates about health care costs this fall.

  • A Note on How the War in Iran May Affect Health Care in the Midterms

    From Drew Altman

    In a new column, Dr. Drew Altman, KFF’s President and CEO, discusses the impact of the war in Iran and rising gas prices on voter concerns about health care costs. He writes: “Recently, we saw health care costs rise to the top of the public’s list of economic worries, ahead of food, housing, utility costs and the cost of gas….Expect gas prices to rise and health care costs to fall on the list of affordability…

  • ACA Marketplace Survey Feature Image - Website

    Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees

    Poll Finding

    This KFF survey is a follow-up survey of adults who had ACA Marketplace insurance in 2025. The survey examines the cost concerns and coverage changes that these 2025 Marketplace enrollees are experiencing following the expiration of the enhanced premium tax credits. The survey finds that half of returning enrollees say their health care costs are “a lot higher” and most expect to cut back on basic household expenses to afford coverage.

  • ACA Marketplace Survey Feature Image - Website

    KFF Follow-Up Survey of Marketplace Enrollees: Following End of Enhanced Credits, Half of Marketplace Enrollees Now Say Costs Are a Lot Higher, Most Expect to Cut Back on Basic Household Expenses to Afford Coverage

    News Release

    Following the expiration of the enhanced premium tax credits for people with Affordable Care Act (ACA) Marketplace plans, a new KFF follow-up survey of the same Marketplace enrollees KFF surveyed in 2025 finds half (51%) of returning enrollees say their health care costs are “a lot higher” this year compared to last year, including four in ten who specifically say their premiums are “a lot higher.”

  • Eight Trends Shaping 2026 Health Care Costs

    Other Post

    A new Peterson-KFF policy explainer lays out the health care trends shaping the 2026 policy debates, including rising premiums, spending on prescription drugs, health care price transparency and consolidation, artificial intelligence in health care, Medicaid funding cuts and other key program changes.

  • Quote from Alina Salganicoff, KFF Senior Vice President and Director for Women’s Health Policy. It says, “The Administration’s latest funding deadline and guidance shift intensifies pressure to the reproductive health safety net at a time when the number of uninsured individuals is projected to rise due to Medicaid cuts and expiration of enhanced Affordable Care Act premium tax credits, and Planned Parenthood clinics have lost their federal Medicaid funding.”

    Navigating Uncertainty: The Latest Challenge to the Title X Family Planning Safety Net

    Quick Insights

    The Administration's latest funding deadline and guidance shift intensifies pressure to the reproductive health safety net at a time when the number of uninsured individuals is projected to rise due to Medicaid cuts and expiration of enhanced Affordable Care Act premium tax credits, and Planned Parenthood clinics have lost their federal Medicaid funding.

  • Calculadora del Mercado de Seguros Médicos

    Feature

    Esta calculadora ilustra las primas (el costo mensual de su seguro) y subsidios para las personas que compran seguro médico por su propia cuenta en el mercado de seguros de salud (o de intercambio) creado por la Ley de Cuidado de Salud a Bajo Precio (Affordable Care Act, ACA, en inglés). Con esta calculadora, usted puede introducir diferentes niveles de ingresos, edades, y el tamaño de su familia para obtener un estimado de su elegibilidad…

  • Health Insurance Marketplace Calculator

    Feature

    The Health Insurance Marketplace Calculator, updated with 2025 premium data, provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA).