With one vote on the ACA tax credits in December, no agreement on a plan, and no commitment from the House or Trump, there is no apparent path to extending the credits. It means the issue will prosecuted in the midterms, and it means pain for tens of millions of Americans.

Not this again. Insurance provides access to health care, so it’s actually health care that “doesn’t save lives”, statistically in the aggregate, because most people aren’t sick. But if you get sick, it absolutely does. Anybody ready to go without it. www.washingtonpost.com/business/202...

Trump has now called for replacing the ACA (again) so people can buy skimpier policies from insurance companies (again)?? In a shutdown debate where tax credits are the issue not the popular law. As a negotiating strategy that’s tripling down.

Many implications of the big Dem win tonight. One for health care: it could provide an incentive for Republicans to make a deal on ACA tax credits to deny Democrats the issue in the midterms and further momentum.

Who are MAHA parents? The breakdown from our poll with the @washingtonpost.com: on.kff.org/477Oo5L

GLP-1s in the real world of Mississippi Medicaid: the people and the costs. Check out this story from our Phil Galewitz:

Four in ten who buy their own coverage say they would go without coverage if ACA premiums doubled. They will increase 114% if enhanced tax credits are not extended: on.kff.org/4nACyIk

Politically its Republicans in swing districts who could lose who have to worry most about ACA premium hikes blowing back on them. But its Republicans everywhere whose constituents will be most affected by the hikes: on.kff.org/3VQ3kjF

Another reason health costs will spike. Get ready for a run on GLP-1’s by admirals and generals. thehill.com/policy/defen...

They are going to need a new poster. Our new number, based on new information: ACA premiums will rise an average of 114%. on.kff.org/3WfWxjj

Two KFF findings Republicans might want to consider when deciding how much they care about the looming 100+% premium spike: More than 1/4 of farmers and ranchers are marketplace enrollees. Almost 1/2 of enrollees are small business owners or work for them.

The Senate’s failure to pass a spending bill last week raises the stakes for 24M people in the ACA marketplaces who could see significantly higher premiums next year if the enhanced tax credits expire. More from @drewaltman.bsky.social via @nytimes.com: nyti.ms/46k2XE2

In his latest column, KFF’s @drewaltman.bsky.social explains how higher health insurance premiums in the marketplaces — if enhanced ACA tax credits expire — could strain family budgets already stretched by food, housing, and utility costs. https://on.kff.org/48wSuXi

How will it affect family budgets if the ACA enhanced tax credits are not extended? For lower income (23k) the increase alone is a quarter of what they spend on food. More moderate income (80k), well more than 2x their food budget. My latest column:

Our tracking polls on health misinformation and trust have found a large muddled middle. Confused and unsure who and what to believe they are up for grabs. Yesterday’s announcement on Tylenol and autism will add significantly to it.

We work hard at @kff.org to be experts who are communicators, too. It’s why I say “communications is everyone’s job” here. A great example today in JAMA from @larrylevitt.bsky.social Levitt — storylines for The Pitt.

Will it add to the seemingly growing pressure to make a deal and extend the enhanced ACA tax credits to learn that - half of all marketplace enrollees work for small businesses or are self employed?

Our poll of parents on vaccines with the Washington Post suggests there may be more blowback than imitation after Florida’s move to eliminate childhood vax requirements. Even 7 in 10 MAGA parents support the requirements (and 82% of FLA parents).

As sources of vaccine info move away from CDC and fragment — to doctors, state health departments, professional societies — this is who the public trusts:

The ACA tax credits are the biggest unresolved health policy issue before Congress. But with both sides bobbing and weaving, and the news media focused elsewhere, the prognosis is unclear. on.kff.org/3HTxsHy

Everybody is schizophrenic about prior authorization. They hate it, but they need it to control costs and limit unnecessary care. So they try to do it smarter. Except there’s one group who has no use for it at all: Patients.

Just 14% of the public have a lot of trust in CDC on vaccines. How many will trust it after this week’s ugly purge? Was that the idea?

Katrina: KFF remembers the pain and the progress: www.washingtonpost.com/wp-srv/speci...

Just 16% of the public say mRNA vaccines are unsafe. Even 59% of MAGA supporters say they “don’t know enough to say.” Confusion, not trust, is the vaccine issue. on.kff.org/3HlGRaF

Is lack of confidence in the safety of vaccines the problem, or distrust in the traditional sources of information about vaccines? My latest column:

Three of the ESPN stories about our survey with them of 1988 NFL players: 1) Survey: Most NFL retirees would play again despite costs

When football "trumps" health? Football has serious long-term health consequences, and in our novel survey of 1988 pro players with ESPN out today, the pain and suffering comes pouring out, even as the players also say they would do it all over again.

Are we hyping the role of influencers in health? My latest column, with new data.

Sara Kliff’s great piece inside the R mind on health coverage: nytimes.com/2025/08/01/h... R’s have always discounted coverage but won’t say it to voters or give up their own. And viewed Medicaid as welfare warranting work: on.kff.org/4ogpUix

Prior-auth may be the pre-x of today. Most see it as a big problem for them. Few think the recently announced voluntary initiative to curb it will amount to much. Our latest tracking poll:

65% of Medicaid beneficiaries say the new tax and spending law will hurt them. From our latest tracking poll:

CBO now says there will be 10m more uninsured from the “OBBB.” But the estimate of 4.2m uninsured from the enhanced ACA tax credits expiring at the end of the year stands. So we are looking at 14+ million more uninsured over 10 years unless that changes.

The $50 billion rural hospital/health care grant program can’t help but do a lot of good. It’s also likely to be highly political and isn’t timed or targeted to help a lot with Medicaid cuts. My latest column:

The ACA was not popular when it passed (remember death panels), but it was more popular than the “ OBBB” is today.

Did conservative R’s achieve THEIR “OBBB” health goals? SPENDING CUTS: A trillion. Yes. POLICY: No block grant or per capita cap. The expansion remains. Work requirements. Mixed. POLITICS: Most cuts impact after midterms. TBD. Is it good for the country? Different question.

Democrats will mow make Medicaid cuts a midterm election issue. But they face one big question ahead of that: will they shut down the government over extending the ACA tax credits? Premiums will spike and 4.2 million more people will be uninsured (CBO) if the credits lapse.

Levitt, NYT, the facts on the OBBB. Just out:

With the Scott amendment to the OBBB pulled, the three things that went too far for R’s: defunding Medicaid expansion (Scott); a per capita cap, a block grant. After the OBBB, will not extending the ACA tax credits be the fourth?

Scott's amendment eliminates enhanced match for expansion, but for new enrollees in 2031, adding savings now to the OBBB but putting pressure on congress to reinstate funding in the future while playing chicken with the expansion population in 40 states.

And Medicaid cuts are only part of the story. Premiums rise by as much as 90% for Marketplace enrollees in rural areas if ACA tax credits are not extended by the end of the year, leaving millions uninsured. Another blow to rural health a $25b fund can’t compensate for.

A $25b rural hospital fund is barely a fig leaf compared to massive 10-year cuts in Medicaid payments and Medicaid and ACA coverage. But it will sound big to many voters and its cover for some Rs to vote for the bill. Will the media call it like it is?

My favorite interview I ever did was on Bill Moyers show. A real discussion. Bill wanted to explain, educate, inform. He made the country better.

It’s remarkable how much of the debate about Medicaid cuts is now about hospitals and a rural hospital fund to placate critics and appear to soften the blow, not the millions of people who will lose coverage or find it unaffordable. Some will lose SNAP benefits at the same time.

BIG attention grabber from Wakely, which says the marketplaces will shrink 47-57% if tax credits expire and reconciliation changes are made.

On the health insurance industry/administration announcement today about paring back prior authorization. Will they actually do it? The history of voluntary efforts is not good. If they do, will they raise premiums and cost sharing to compensate?

Active duty troops in LA diverts attention from: everything in the reconciliation bill including Medicaid cuts, firing the vaccine advisory committee, tariffs, Ukraine and more. NOT suggesting intent, it just does. Possibly it should?

You might think he was the for-profit hospital guy. But he was a leading advocate for access to care and smart health policy, always focused on those less fortunate. Respected by everyone. Not was. Is. No one better in our field.

Our new Tracking Poll: Approximately 10 million MAGAs and non-MAGA Republicans in the Marketplaces, almost half of total enrollment. I will have more to say about this in my column on Tuesday.

The great flaw in “decide with your doctor”.  The vast majority of practicing docs are not scientists they rely on scientific guidelines. Erode trust in them or take them away and you have 300k primary care docs plus specialists making stuff up.

As more Medicaid and ACA changes pour in tonight from Congress, one thing strikes me as a former state human services secretary. For them or against them, the assumption that states will implement so many new policies and programs at once on time and as designed is, well, fantasy.