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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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  • What’s in There? An Ask-the-Experts Overview of the Health Reform Law

    Event Date:
    Event

    The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 are now law. But many people have questions about the new reforms. To answer questions about the major provisions of these two laws, the Alliance for Health Reform and The Commonwealth Fund sponsored an April 16 briefing. For more information, please visit Alliance's event page. Full Video   Speakers for this session: The panel is co-moderated by Karen…

  • What’s in There? The New Health Reform Law and Private Insurance

    Event Date:
    Event

    This briefing focuses on how the reform law affects access to private coverage, including the new federal high-risk pools, tax credits for small businesses, health insurance exchanges, the individual mandate and employer obligations. This briefing, cosponsored by the Alliance for Health Reform and the Kaiser Family Foundation, explored these and other issues. For more information, please visit Alliance's event page. Full Video    Speakers for this session: The panel is co-moderated by Diane Rowland of…

  • Community Health Centers in an Era of Health Reform: An Overview and Key Challenges to Health Center Growth

    Issue Brief

    Over 1,100 federally funded community health centers play a vital role in ensuring access to health care for a predominantly low-income population in medically underserved communities. Health centers’ ability to provide comprehensive primary care and improve access to high-quality care while holding down health care cost growth has been well-documented. As health reform spurs coverage expansion and efforts to improve quality, the nation’s reliance on health centers is likely to grow. In the Affordable Care…

  • Report and Video Highlight Health Coverage Struggles, Other Economic Concerns of Working Families

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    Event

    This report and video from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU) illustrate the financial struggles of many families in the United States and show the central role of health care costs and coverage in a household's economic stability. The report, Snapshots from the Kitchen Table: Family Budgets and Health Care, is based on interviews with 27 families from six cities across the U.S.. It finds pervasive uncertainty over job security…

  • 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…

  • Health Care and the Economy in Two Swing States: A Look at Ohio and Florida

    Poll Finding

    Two new surveys by NPR, the Kaiser Family Foundation and the Harvard School of Public Health examine the pocketbook problems facing people in Ohio and Florida -- two presidential swing states -- including their struggles with gas prices, getting and keeing a well-paying job and affording health care. The surveys, , also take an in-depth look at the impact of medical bills on family finances and health care, and provide insights into the way health…

  • National Health Insurance — A Brief History Of Reform Efforts In The U.S.

    Issue Brief

    This policy brief provides an overview of health reform efforts in the United States over much of the last century, from New Deal-era calls for government-subsidized health coverage to the creation of Medicare and Medicaid in the 1960s and the failed attempt at universal coverage in the early 1990s. Issue Brief (.pdf)

  • Medicaid as a Platform for Broader Health Reform: Supporting High-Need and Low-Income Populations

    Issue Brief

    Medicaid is the health insurance safety net for nearly 60 million of the nation's poorest and sickest individuals. It provides access to a comprehensive scope of benefits with limited cost-sharing that is geared to meet the health needs and limited resources of the low-income, high-need populations it serves, populations for whom private coverage is often not available, not affordable or inadequate. This paper, based on years of research and analysis from the Kaiser Commission on…

  • Health Care and the Middle Class: More Costs and Less Coverage

    Report

    This analysis paper examines the availability, affordability and stability of the health insurance coverage of the American middle class, defined as those with incomes of $44,000 to $88,000 for a family of four. It also addresses the growing burden of health care costs for the middle class, the adequacy of today's health insurance plans to protect them from large medical bills, and the difference both make as individuals and families make health care decisions for…