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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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  • Listening to Trump Voters with ACA Coverage: What They Want in a Health Care Plan

    Issue Brief

    President Donald Trump and Republicans in Congress are moving to follow through on their campaign promise to repeal and replace the Affordable Care Act (ACA). To gain a better understanding of the personal experiences of Trump voters with health coverage provided through the ACA and the changes they hope to see in the health system moving forward, the Kaiser Family Foundation (KFF) held focus groups in December 2016 with Trump voters in cities in three…

  • Web Briefing for Journalists – Potential Changes to Health Care Access and Coverage: What’s at Stake for Women?

    Event Date:
    Event

    House Republicans’ American Health Care Act and other actions under discussion by President Donald Trump’s administration and the new Congress could profoundly affect access to health care for many women. Repeal of the Affordable Care Act, changes to its birth control coverage provision, and new state and federal abortion restrictions, along with potential funding cuts and restrictions for family planning providers, including Planned Parenthood, would significantly impact the availability and cost of women’s health care,…

  • Estimates: Average Monthly Premium after Tax Credit Would Be 74% Higher Under Senate Health Bill in 2020

    News Release

    A new analysis from the Kaiser Family Foundation estimates that the average monthly premium for a benchmark silver plan after tax credits in 2020 would be 74 percent higher under the Senate’s Better Care Reconciliation Act (BCRA) compared to the Affordable Care Act (ACA). Overall, most marketplace enrollees would pay higher premiums under the Senate bill than current law, the analysis finds. Older and lower-income enrollees would see the biggest increases, with people age 55-64…

  • ACA Replacement Plans and the Individual Market

    Feature

    This slideshow compares premiums and tax credits under proposed replacement plans for the Affordable Care Act, including the Senate's Better Care Reconciliation Act and the House-passed American Health Care Act.

  • Association Health Plans for Small Groups and Self-Employed Individuals under the Better Care Reconciliation Act

    Issue Brief

    A provision in the Senate Better Care Reconciliation Act (BCRA), a bill to repeal and replace the Affordable Care Act (ACA), would establish association health plan options for small employers and self-employed individuals. For these plans, the requirement that premiums cannot vary based on health status would not apply. This brief describes how association health plans could affect premiums in the small group and non-group markets.

  • Medicaid’s Role in Louisiana

    Fact Sheet

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

  • Medicaid’s Role in Nevada

    Fact Sheet

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

  • Medicaid’s Role in Kentucky

    Fact Sheet

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

  • State-by-State Estimates of Reductions in Federal Medicaid Funding Under Repeal of the ACA Medicaid Expansion

    Issue Brief

    Congressional debate around the Affordable Care Act (ACA) has recently included a proposal to repeal the ACA, including the provision allowing states to extend Medicaid to childless adults up to 138% FPL and providing enhanced federal funds for the Medicaid expansion. This brief provides estimates of changes in federal Medicaid funds and Medicaid coverage for adults covered through the ACA expansion if the expansion is eliminated starting in 2020. A repeal of the Medicaid expansion…