New: With first year awards from the rural health transformation fund out, our analysis shows wide variation in the amount per rural resident across states. www.kff.org/state-health...

The reconciliation law signed by President Trump last year eliminated eligibility for Medicaid, ACA, and Medicare coverage for asylum seekers, including those from Venezuela. www.kff.org/immigrant-he...

The news out of Venezuela has understandably pushed health care costs out of the headlines, but the issue hasn’t gone away. @velshi.com carved out some time today to dive in. www.ms.now/ali-velshi/w...

New year, new unaffordable healthcare costs. KFF's @larrylevitt.bsky.social joins me at Noon ET to dive into what the lapse of #AffordableCareAct subsidies could mean for you and your health as premiums spike for millions of Americans. #Velshi

The end of ACA enhanced premium tax credits, and an average out-of-pocket premium increase of 114% for 22 million people, has been hypothetical. Now it is real.

The Trump administration has announced the first awards from the temporary $50 billion rural health fund passed earlier this year. These grants, while valuable, will not make up for $911 billion in Medicaid cuts over a decade, including $137 billion in rural areas.

I suspect many people would be fine with getting rid of insurance companies. It’s how you then guarantee broad access to health care where there would be big disagreements.

The ACA has faced legal or political uncertainty at the end of almost every year since it passed. This year is no different, with expiring enhanced premium tax credits.

There is no absolute drop-dead date for extending the enhanced ACA premium tax credits. www.kff.org/quick-take/t...

A discharge petition in the House paves the way for a vote on a three-year extension of the ACA’s enhanced premium tax credits, which expire on 12/31. But there is no drop-dead date for an extension, writes KFF’s @larrylevitt.bsky.social #QuickTake on.kff.org/3MFGAl8

A vote in January to extend enhanced ACA premium tax credits wouldn't help people get coverage by January 1. But, open enrollment could be extended and the premium assistance would apply for all months an enrollee is covered.

And Congress sounds like it is punting on the enhanced ACA subsidies, despite moderate Rs hopes. Mike Johnson: “Many of them did want to vote on this Obamacare covid-era subsidy the Democrats created. We looked for a way to try to allow for that pressure release valve, and it just was not to be.”

With no extension of enhanced tax credits, ACA enrollees are going to start the year with premium payments increasing by an average of 114%, or over $1,000 a year per person. Some will find a way to pay it, some have switched to higher deductibles, and some have dropped coverage.

“This is kind of a greatest hits of Republican health care ideas of the last decade,” said Larry Levitt, executive vice president for health policy at KFF. www.cnn.com/2025/12/15/p...

The looming expiration of enhanced ACA tax credits, would cause out-of-pocket premiums to increase by 114% on average. The Senate Democratic plan would avert the increase in premium payments. The Republican plan would not, but cushions the effect with health savings accounts.

I'd say this pretty much seems up the ACA debate in the Senate today. www.politico.com/live-updates...

A finding from this survey that challenged my priors is that ~50% people with individual/Marketplace coverage have had it for 3+ years If the subsidies expire, it won't just affect people cycling in and out of coverage — it'd hit a stable group who’ve built their budgets/care around these premiums

Get ready to learn a very wonky term: "effectuated enrollment." It's the number of people who sign up for ACA coverage or get auto-renewed and then pay their premiums. It's going to matter a lot if enhanced tax credits expire and people face an average increase in premium payments of 114%.

Pre-existing conditions -- which led to a denial of individual health insurance before the ACA -- are highest among older working age people without a college degree. www.bloomberg.com/opinion/arti...

Under the Senate Republican ACA plan, premium payments would still more than double next year. Healthy people could be better off in a high deductible plan with a health savings account. People who are sick would face big premium increases or a deductible they can't afford.

The current ACA debate is the rerun of a movie we’ve seen many times. Democrats want more spending to make health care more affordable. Republicans want less spending and regulation and more people in lower premium high deductible insurance plans with health spending accounts.

Weedy but important detail: The HSA lump sums would only be available to enrollees opting into the skimpiest — catastrophic or bronze-tier — ACA plans. Most Marketplace enrollees in most states have incomes < 250% FPL and receive extra help with cost-sharing — but only if enrolled in a silver plan

The average increase in out-of-pocket premiums if ACA enhanced tax credits expire is $1,016, so these HSA contributions would be similar to that. But, the average deductible in a bronze plan will be $7,476, so a $1,000 or $1,500 HSA will leave people quite exposed.

Senator Cassidy’s health plan poses tradeoffs. Healthier people would benefit from contributions to health savings accounts and low premium high deductible plans. Sicker people would end up with higher premiums or higher deductibles. But, it wouldn’t destabilize the ACA. www.kff.org/affordable-c...

KFF’s @larrylevitt.bsky.social appeared on @kqedforum.bsky.social and spoke about our latest research on the ACA enhanced premium tax credits, including the potential impact on people and politics if the tax credits aren’t extended. 🎧 Listen to the full episode: https://on.kff.org/4awg4nY

🎙️ON AIR: We're talking to @kff.org's @larrylevitt.bsky.social, @thebulwark.com's @citizencohn.bsky.social and @liccardo.house.gov of California's 16th District about the negotiations unfolding as Congress scrambles to address healthcare funding before year end. ❓What are your Qs? 📻 Listen:

Doubling of out-of-pocket premiums for ACA enrollees isn’t hypothetical. We estimate premium payments will rise by an average of 114%, or $1,016, next year if the enhanced tax credits end.

In trying to come up with a health care proposal right now, Republicans face the same dilemma as with any health reform plan. Laying out the details will make clear who wins, but also who loses.

One of the weedy things I worry/wonder about is (1) how aware of the premiums changes enrollees are, and (2) among those who aren't aware, how many are having their premiums automatically debited from their bank accounts?

One of the challenges in explaining the impact of enhanced ACA tax credits expiring on premium payments is that it varies so much, depending on income, age, family size, and geography. The average increase would be 114%, or $1,016, but there is a wide range.

I'm not sure how to say this any more simply. ACA premium tax credits are for people, not insurer. People receiving a tax credit can use it to buy any plan in the ACA marketplace. As an administrative mechanism, the government then forwards the tax credit to the chosen insurer.

Concepts of a health care plan? Still in the conceptual phase, it would seem www.thebulwark.com/p/trump-disc...

No Republicans voted for the Inflation Reduction Act, giving Medicare authority to negotiation drug prices. But, the Trump administration seems to be all in, touting big discounts in the latest round of negotiation.

KFF’s @larrylevitt.bsky.social advises signing up now, because once enrollment open ends you won’t have another chance. You can sign as a hedge, in case a deal is passed, and decide to drop out later if there’s no deal.

It's always harder to get things done in Washington than to stop things. In the case of the ACA right now, inaction means 22 million people will see their out-of-pocket premiums increase by 114% on average on January 1.

People have to sign up for ACA marketplace coverage by December 15 to have health insurance January 1. Even if Congress passed an extension with tweaks to the premium tax credits, computer systems could not be reprogrammed immediately.

I was genuinely interested to see President Trump's health plan today. Guess we'll have to wait longer.

(Yes, it's stupidly complicated, but no, funding CSRs would not do anything to reduce out-of-pocket costs relative to status quo; it would instead raise premiums for some enrollees in most states.)

CMS just issued a notice that it will start sharing personal data of Medicaid enrollees with ICE for immigration enforcement, including data on immigration status, location, and phone numbers. @kff.org Quick Take discusses the impact this could have on immigrant families www.kff.org/quick-take/c...

The Scott proposal hews most closely to Trump’s various remarks. “While ACA plans would still be required to cover people with pre-existing conditions under the Scott proposal, it is likely that the ACA Marketplace would collapse in states that seek a waiver under his approach.”

Proposals from Senators Scott and Cassidy to convert ACA premium tax credits into health accounts present trade-offs that benefit healthy people at the expense of sick people. Senator Scott's proposal, in particular, would destabilize the insurance market in some states. www.kff.org/affordable-c...

ACA enrollment growth since enhanced premium tax credits were put in place is dramatically skewed towards red states. Yet, no Republican voted for the ACA originally, or for the enhanced tax credits. www.kff.org/affordable-c...

No one likes prior authorization review. But could we get rid of it? My new column: www.kff.org/from-drew-al...

The trillion dollars in health care cuts passed by Republicans earlier this year are backloaded and mostly won't take effect before the midterms. Letting enhanced ACA tax credits expire would take effect January 1, leading to big out-of-pocket premium increases and more people uninsured.

We also need to know *which* subsidies are in play. As I understand it: Paragon has proposed converting CSRs to HSA contributions Cassidy has proposed converting ePTCs to HSA contributions Trump has proposed (I think? this is least clear) converting *all* subsidies to HSA contributions.

Wonky but important question for understanding the effects of proposals to convert ACA premium tax credits to health savings accounts: How big would the contributions be? Would they vary by income, age, and geography in the same way as the premium tax credits?

Really excited to share our latest survey of immigrants work @kff.org. We're able to see how immigrants are faring now amid increased immigration enforcement compared to 2023. Check out our KFF reports below and stories from @nytimes.com

Our brand new survey of immigrants in partnership with @nytimes.com explores immigrants views and experiences under the second Trump administration. It finds increased fear, health and economic challenges amid immigration enforcement, but a remarkable resilience as well www.kff.org/kff-nytimes-...

New survey from @kff.org and @nytimes.com reveals deepening anxiety and fear among immigrants of all statuses amid the Trump administration’s intensified immigration enforcement and restrictive policies www.kff.org/kff-nytimes-...

Leaving aside the issue that people buying insurance would buy it from insurance companies. This sounds like an effort to let people bypass the ACA. Healthy people could buy cheaper insurance that doesn't cover pre-existing conditions, sending the ACA into a premium death spiral.