Summer may be approaching its end, but the health policy stories that have marked the season continue. In Washington and across the country, public health officials are still struggling with outbreaks of vaccine-preventable diseases such as measles, while states and health systems are preparing for the impact of major federal funding cuts to their Medicaid programs.

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Among the takeaways from this week’s episode:

• More Americans are struggling to afford health coverage, even before some of the biggest GOP-initiated changes to Medicaid and Affordable Care Act plans take effect next year. And the federal government’s efforts to block coverage of drugs used in gender-affirming care and to claw back ACA subsidies are creating access issues for a wider pool of Americans.

• Pennsylvania health officials this week reported two measles-related deaths amid an ongoing outbreak and the national debate over vaccines. While many of the actions taken by the U.S. Department of Health and Human Services under Robert F. Kennedy Jr. remain held up in litigation, President Donald Trump has made his personal skepticism about vaccines known, including through his recent executive order. Meanwhile, the administration is scaling back enforcement of civil rights protections for people with autism.

• The Trump administration is inviting states to participate in price negotiations with manufacturers over GLP-1 drugs if the states opt to offer the drugs through their Medicaid programs. But, amid concerns over cost, only one state has taken the federal government up on its offer.

• And farewell to Dolly Parton, the superstar country music singer and songwriter, also known for her philanthropic work, who died this week at age 80. In addition to her donation in 2020 supporting the development of the mRNA-based covid vaccine, Parton funded pediatric infectious disease research, a women’s health center in the Tennessee county where she was raised, and training for pediatric medical professionals.

Also this week, Rovner interviews Dean Rosen about his work for former Sen. Nancy Landon Kassebaum, a Kansas Republican and the first woman to lead a major Senate committee, who died last week at age 94.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Mother Jones’ “The Orwellian Company Behind ICE’s New Electric Shock Gloves,” by Sophie Hurwitz.

Shefali Luthra: The 19th’s “Tik Tok’s Fake GLP-1 Market Preys on Women Trying To Lose Weight,” by Barbara Rodriguez.

Alice Miranda Ollstein: The Texas Observer’s “Texas Maternal Mortality Committee’s Next Report Will Skip Post-‘Roe’ Deaths. Lawmakers Suspect Political Influence,” by Mary Tuma.

Joanne Kenen: Politico’s “AI Slop Is Swamping a House Office That Drafts US Laws,” by Owen Dahlkamp.

Also mentioned in this week’s podcast:

• NOTUS’ “‘Graveyard for Grants’: NIH Is Holding Up Medical Research Funding,” by Paige Winfield Cunningham.

• The Associated Press’ “The CDC Has Zombie Programs. Congress Funds Them, but Few People Are Left To Do the Work,” by Mike Stobbe.

• KFF Health News’ “Kennedy’s Quiet Hunt for Autism Culprits Stalls as Trump Orders Baseless Changes to Childhood Shots,” by Amanda Seitz and Stephanie Armour.

• The Wall Street Journal’s “Costco Sells Vacations, Gas and, Soon, Medicare Plans,” by Anna Wilde Mathews.

• Stat’s “Epic’s Alleged Anticompetitive Practices Under Scrutiny From Federal, State Investigators,” by Casey Ross and Brittany Trang.

• Stat’s “UnitedHealth Faces IRS Probe Over Potential Tax Avoidance,” by Bob Herman.

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While the 2025 Proclamation only applied to new H-1B visa petitions from outside the U.S., the fee under the proposed rule would apply to all H-1B visa petitions subject to the annual cap, including those already in the U.S. converting to an H-1B visa. Since the fee is applicable at the time of petition filing, it will apply to a significantly larger number of petitions than the 85,000 approved annually under the cap, including those that are not approved. Employers that are exempt from the annual cap, such as institutions of higher education, government research organizations, and certain nonprofits, will be exempt from the fee. However, private employers of any size, including small businesses and private hospitals, will be subject to the fee. Petitions for H-1B extensions, amendments, and transfers are not subject to the fee.

The proposed $103,265 fee could lead to reductions in U.S. health care workforce, increasing barriers to care. KFF analysis of U.S. Citizenship and Immigration Services data shows that new H-1B visa approvals for the health care and social assistance industries increased by around 18% between 2022 and 2025 (Figure 1). A decline in H-1B workers would disproportionately impact states that employ the largest shares of H-1B workers (NY, MA, CA, and PA), lower income and rural areas where H-1B health care workers often are employed, and smaller employers, who would face greater challenges paying the fee.

Public comments on the proposed rule are due by September 24^th, 2026, after which the DHS is legally required to review and consider the feedback received before it can publish a final rule. Although the proposed rule does not mention an implementation date, the rule could go into effect as early as March 2027, when the registration period for the following fiscal year’s H-1B cap officially opens.

Drishti Pillai
Associate Director, Racial Equity and Health Policy
Director, Immigrant Health Policy

Heidi Overton, a physician and White House domestic policy adviser, is President Donald Trump’s choice to be the next head of the Food and Drug Administration. Overton, an abortion opponent and supporter of Trump’s proposed changes to the childhood vaccine schedule, has made enemies while working on health policy from the White House and could face some tough questioning from senators.

Meanwhile, prescription drug prices are dropping for some people, and the wholesale retailer Costco is entering the Medicare market. Still, overall, the problem of healthcare being too expensive remains stubbornly hard to solve.

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Among the takeaways from this week’s episode:

• Trump’s selection of Overton to lead the FDA is prompting concerns from a diverse crowd of skeptics that includes Sen. Bill Cassidy (R-La.) and adherents to the Make America Healthy Again movement. Her lack of managerial experience and history of controversial writings could be liabilities during the confirmation process, though Trump has a decent track record of clearing nominees through a hesitant Senate.

• Grant money continues to be held up at the National Institutes of Health pending political reviews, and new reporting sheds light on “zombie programs” at the Centers for Disease Control and Prevention, where money has been appropriated but there’s no staff to use it. Plus, the trend of declining childhood immunizations continues, with vaccine exemptions for kindergartners jumping to another high.

• New data shows the largest drop in prescription drug prices since the 1960s, and while the Trump administration is taking credit, it’s unclear what exactly caused it. Meanwhile, the federal government is investigating major health companies for allegedly dodging taxes or engaging in anticompetitive practices. And the wholesaler Costco is getting into the health insurance game, partnering with a nonprofit insurer to provide Medicare Advantage or Medigap plans in a few states.

Also this week, as part of the “How Would You Fix It?” series, Rovner interviews billionaire businessman Mark Cuban, who has already reshaped the generic drug market and now has his eye on the rest of the healthcare system.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Mother Jones’ “The Orwellian Company Behind ICE’s New Electric Shock Gloves,” by Sophie Hurwitz.

Shefali Luthra: The 19th’s “Tik Tok’s Fake GLP-1 Market Preys on Women Trying To Lose Weight,” by Barbara Rodriguez.

Alice Miranda Ollstein: The Texas Observer’s “Texas Maternal Mortality Committee’s Next Report Will Skip Post-‘Roe’ Deaths. Lawmakers Suspect Political Influence,” by Mary Tuma.

Joanne Kenen: Politico’s “AI Slop Is Swamping a House Office That Drafts US Laws,” by Owen Dahlkamp.

Also mentioned in this week’s podcast:

• NOTUS’ “‘Graveyard for Grants’: NIH Is Holding Up Medical Research Funding,” by Paige Winfield Cunningham.

• The Associated Press’ “The CDC Has Zombie Programs. Congress Funds Them, but Few People Are Left To Do the Work,” by Mike Stobbe.

• KFF Health News’ “Kennedy’s Quiet Hunt for Autism Culprits Stalls as Trump Orders Baseless Changes to Childhood Shots,” by Amanda Seitz and Stephanie Armour.

• The Wall Street Journal’s “Costco Sells Vacations, Gas and, Soon, Medicare Plans,” by Anna Wilde Mathews.

• Stat’s “Epic’s Alleged Anticompetitive Practices Under Scrutiny From Federal, State Investigators,” by Casey Ross and Brittany Trang.

• Stat’s “UnitedHealth Faces IRS Probe Over Potential Tax Avoidance,” by Bob Herman.

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While the DHS guidance provides more details on public charge determinations under the new rule, it leaves key concepts unspecified and grants substantial discretion to individual immigration officers. This will likely result in ongoing confusion and fear among immigrant families that may deter them and their citizen children from participating in programs that help pay for health care, housing, or food even if they are eligible. KFF analysis shows that the rule and other immigration-related fears could lead to 1.4 million to 4.1 million Medicaid and CHIP enrollees who are living in a household with at least one noncitizen to disenroll, including about 560,000 to 1.7 million citizen children (Figure 1).

Prior regulations and guidance defined a public charge as someone likely to become primarily dependent on the federal government as demonstrated by the use of cash assistance programs for income maintenance or government-funded institutionalized long-term care. They excluded non-cash assistance programs, including health coverage, from public charge determinations. In contrast, the new guidance does not define public charge, instead indicating that officers should assess whether the individual is, “likely at any time to depend on means-tested public benefits.” Moreover, it does not limit or specify which means-tested benefits officers may consider.

In lieu of specifying benefits, the guidance directs officers to consider a broad array of means-tested programs, “including but not limited to cash assistance, public or assisted housing, financial aid for postsecondary education, food assistance, government-funded health coverage, or any other similar benefit for which payments or assistance are provided to an individual, household, or family eligibility unit.” It indicates these include programs funded by any federal, state, Tribal, territorial, lor local government entity. It clarifies that benefits such as Social Security, Medicare, and unemployment insurance—for which eligibility is based on payments into the system—are NOT considered means-tested. While the guidance specifies that receipt of means-tested public benefits occurs when an individual (versus family members or children) is receiving the benefit, it also notes that, if an individual’s children or family members are receiving a means-tested benefit based on the individual’s income or assets being below a certain level, then the officer should consider the income or assets falling below a threshold as a factor.

The guidance reaffirms that determinations be made based on a “totality of circumstances,” meaning that any one factor, including benefit use, does not determine whether someone is a public charge. It also outlines how officers should consider statutorily required factors in making determinations, including age, health, and disability.

The rule and guidance will be applied to applications for adjustment of status postmarked or submitted on or after September 18, 2026.

Samantha Artiga
Senior Vice President
Director for Racial Equity and Health Policy Program

President Donald Trump, apparently unhappy with the slow pace of efforts to change the federal government’s childhood vaccine schedule, issued a new executive order this week that would, if implemented, upend how children are protected from communicable diseases. But there are many obstacles to carrying out the president’s initiative, both legal and political.

Meanwhile, Health and Human Services Secretary Robert F. Kennedy Jr. unveiled proposed new rules for food additives this week, but the rules don’t go as far as many health advocates had hoped.

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Among the takeaways from this week’s episode:

• Trump unveiled a new executive order demanding restrictions on childhood vaccine recommendations, among other changes. The main impact of his order so far is confusion, leaving parents with little information on the science that may be informing his policy pronouncements. Meanwhile, Texas Attorney General Ken Paxton — also the Republican candidate for U.S. Senate in the state — is investigating the American Academy of Pediatrics over its vaccine positions.

• The Senate confirmed Trump’s nominee to lead the Centers for Disease Control and Prevention, Erica Schwartz. And during a meeting with CDC workers, Kennedy expressed distrust of career scientists — another blow to staff morale.

• The Trump administration finalized a rule that would strip federal Medicaid funding for states that provide certain care to transgender minors, putting added financial pressure on states. And several GOP-controlled states are passing on the federal government’s self-attestation grace period for Medicaid work requirements, forcing enrollees to start immediately proving with documentation that they qualify for an exemption to the requirements.

Also this week, Rovner interviews KFF Health News’ Paula Andalo, who wrote the latest “Bill of the Month,” about a medical tourist who searched for a better price for elective surgery abroad before finding it out-of-state. If you have a bill that’s outrageous, inscrutable, or just plain infuriating, you can share it with us here.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Health Affairs’ “Remembering Bob Blendon, an Essential Professor, Teacher, and Mentor,” by Mollyann Brodie.

Anna Edney: CBS News’ “Farm Linked to Cyclosporiasis Outbreak Hadn’t Been Inspected in 7 Years as FDA Lags on Foreign Inspection Targets,” by Julia Ingram.

Sandhya Raman: NOTUS’ “An Antidote to the Anti-Vaccine Movement Lives in Rural West Virginia,” by Margaret Manto.

Maya Goldman: The New York Times’ “To Improve Student Mental Health, University of Michigan Eases Grading,” by Mark Arsenault.

Also mentioned in this week’s podcast:

• MedPage Today’s “I Thought the CDC Shooting Was Rock Bottom. We’re Still Sinking,” by Anonymous.

• The Wall Street Journal’s “Trump Turns Up the Heat on RFK Jr. To Cut Back Childhood Vaccines,” by Liz Essley White.

• Politico’s “The Trump Admin Offered Sick Medicaid Patients a 1-Year Lifeline. These Red States Are Rejecting It,” by Alice Miranda Ollstein and Robert King.

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While about half of states already restrict access to gender affirming care, KFF estimates that there are about 130,000 young trans people with Medicaid or CHIP coverage who live in states without restrictions. These enrollees, if they sought gender-affirming care, would face new limitations under the rule if their state does not provide state-funded access.

Despite gender-affirming care being a best medical practice, recommended by major medical groups, including the American Medical Association, American Academy of Pediatrics, and the American Psychological Association, the new rule builds on a range of administration actions aimed at restricting this care, including within the Medicaid program. States have also increasingly sought to limit access, with the number restricting access rising from just 4 in 2023 to 27 states today. Additionally, dozens of providers have ceased to offer services, citing pressure from or fear of the administration. The final Medicaid rule represents the latest barrier to this care, this time focused on limiting access at the payer source.

Specifically, the rule prohibits federal Medicaid dollars from covering puberty blockers, hormone therapy, and surgery (which is very rarely used among young people) for enrollees under the age of 18 in the Medicaid program and under the age of 19 in CHIP. It does not prohibit coverage of counseling or psychotherapy as part of gender-affirming care.

The most significant difference between the final and proposed rule is that the final rule includes a limited tapering period. For enrollees who are receiving hormone therapy as of the effective date of the rule (60 days after publication), federal funds can continue to cover the services “for a tapering period of up to 6 months.” CMS added this provision “after careful consideration of the comments” and “to provide beneficiaries and their treating providers a reasonable opportunity to phase off these medications in a manner that allows for clinical discretion, if desired.” The tapering provision does not apply to puberty blockers.

As noted, the rule does not prevent states from covering these services using state-only funds, and some states may seek to do so. States have faced similar choices in the context of abortion. The federal Hyde Amendment prohibits use of federal Medicaid dollars to pay for abortions outside of specific contexts, but states can use their own funds to cover abortion services more comprehensively, which 21 states do. It would likely be a relatively small expenditure increase for states to absorb gender-affirming care costs given how relatively uncommon and inexpensive these services are. CMS estimates that Medicaid spent about $31 million on the prohibited services for enrollees under 19 years old in 2023, representing 0.003% of all Medicaid spending that year. Theoretically, families could also pay cash for these services, but given the income limits in the Medicaid program, it is not likely many would have the resources to do so. There could also be charitable funds set up at national or local levels.

Looking ahead, access to gender affirming care could become more limited, particularly after the tapering period ends. The rule’s impact would be most significantly felt in states without a ban in place among low-income families. If states do not provide coverage with state-only dollars and care cannot be financed in other ways, thousands of young people could be without a way to access what remains a recommended medical intervention. It is likely that there will be litigation challenging this rule. When the proposed rule was released, multiple state attorneys general and the ACLU immediately stated that they were opposed to the policies and planned to fight them.

Lindsey Dawson
Associate Director for HIV Policy
Director for LGBTQ Health Policy

On August 5, 2026 the U.S. Food and Drug Administration (FDA) approved the first-ever messenger RNA (mRNA) flu vaccine for adults 50 and older. Manufactured by Moderna, the vaccine is expected to be available for the 2026-2027 season. The new vaccine was found to be safe following a trial of roughly 40,000 people, with results indicating the new shots could offer more protection than prior flu vaccines. The COVID-19 vaccines were the first publicly available vaccines in the U.S. to rely on mRNA, and while studies have demonstrated that vaccines using the technology are safe and effective, mRNA technology has long been the subject of attacks and criticism by anti-vaccine groups. Last year, HHS Secretary Robert F. Kennedy Jr. announced the cancellation of $500 million in federal funding for mRNA research.

KFF polling in April 2025 found that most adults ages 50 and older (the age group that will be eligible for the new mRNA flu vaccine) were uncertain whether mRNA vaccines are safe. Views on the safety of mRNA technology differ by partisanship, with Democrats about three times as likely as Republicans to see it as safe; however, at least half of adults 50 and older across partisans said they were unsure whether mRNA vaccines are safe or not.

That second step has had a demonstrable effect. According to a new analysis we released, New Mexico is the only state where ACA Marketplace enrollment has increased, showing that when it comes to affording health insurance, money matters.

New Mexico made childcare “universal” through a mix of trust fund money and new state general fund resources with some of the funds used to raise provider rates and expand capacity.

You might say New Mexico cheated. It has money other states don’t have from a boom in oil and fracking revenues. But there is a point there as well, one that I know well from my time in state government. States sometimes attach sunset provisions to new spending to get legislation passed, or create rainy day funds when they can, but overall, legislatures and governors are captives of state revenue cycles; they spend when revenues are up and cut when they are down. New Mexico is a small state; its budget is about the same size as my human services department’s budget was decades ago in New Jersey, adjusted for inflation. But spending effort and budget pain are proportional; they are not greater in big states.

New Mexico also has democratic control of the governorship and both houses of the legislature, another thing that has mattered. But nationally, no one has gone out of their way to brand New Mexico’s initiatives as progressive or as “socialism.” New Mexico’s Governor Michelle Lujan Grisham has mostly defied moderate and progressive labels, occasionally taking heat from both sides. In the Southwest, I guess, childcare and affordable insurance are viewed more as pragmatic measures than ideological ones. Whether they would be viewed that way if Democrats had control of everything nationally is another matter, suggesting that sometimes under the right circumstances and in the right places, it’s possible to do things at the state level that cannot be done in DC.

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ACA Marketplace insurers’ proposed rate filings for 2027 are now available from all 50 states and the District of Columbia. According to KFF’s analysis, the 15% median increase would be the second consecutive year of double-digit premium hikes (last year’s median finalized premium increase was 20%.)

The Trump administration has conceded in court documents that it used purely political considerations to cancel grant funding previously approved by Congress. But that has provoked a surprisingly muted response from lawmakers, who under the Constitution control the power of the purse.

Meanwhile, Republicans in the Senate summoned former National Institutes of Health and White House official Anthony Fauci to testify — again — about his handling of the covid pandemic. Fauci, however, refused to answer questions, citing the advice of his attorneys.

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Among the takeaways from this week’s episode:

• Recent court filings shed light on how the Trump administration has used politics to justify its decisions to cancel federal grants. While similar revelations may have been explosive under other presidents, the filings have triggered muted, if any, responses from lawmakers.

• The Trump administration announced this week that it would end the temporary Medicare Part D subsidies, introduced under the Biden administration, that help lower the monthly premiums older Americans pay for drug coverage. While next year’s premiums probably would have increased anyway, the change — which many will notice when they shop for plans later this year, shortly before the midterm elections — may not help Republicans in the voting booth.

• Meanwhile, Sen. Rand Paul (R-Ky.) brought Fauci before the committee he chairs to address accusations related to his role in the nation’s covid response as a key adviser to Presidents Donald Trump and Joe Biden. But little of substance was said, with the hearing quickly devolving into political grandstanding as Fauci asserted his constitutional right not to self-incriminate.

• An FDA advisory panel voted to recommend the agency make it easier for Americans to obtain several previously banned compounds known as peptides — even as FDA staff caution that there’s no evidence they are safe. The panel included members who stand to profit from expanded access to peptides.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The Arkansas Times’ “Postpartum Women Go Without Care as Arkansas Holds Out as Lone State To Deny Them Medicaid,” by Byron Tate.

Rachel Cohrs Zhang: KFF Health News’ “Trump Administration Demands Hospitals Share Emergency Room Records,” by Amanda Seitz, Maia Rosenfeld, and Darius Tahir.

Liz Essley Whyte: Stat’s “E-Bikes, E-Scooters Are a Burgeoning Pediatric Public Health Emergency,” by J. Todd R. Lawrence and Madison A. Kesler.

Shefali Luthra: The Washington Post’s “The Problem With RFK Jr.’s Crusade Against Antidepressants,” by Aaron E. Carroll.

Also mentioned in this week’s podcast:

• The New York Times’ “Trump Administration Admits Canceling Grants to States That Did Not Vote for Him,” by Tony Romm and Brad Plumer.

• CalMatters’ “White House Admits It Used Keywords To Kill Billions Worth of California Research Grants,” by Mikhail Zinshteyn.

• The Wall Street Journal’s “Trump Turns Up the Heat on RFK Jr. To Cut Back Childhood Vaccines,” by Liz Essley Whyte.

• Bloomberg News’ “From TV Doctor to Power Broker: Dr. Oz Thrives on Trump’s Team,” by Rachel Cohrs Zhang.

• KFF Health News’ “Trump Has Quietly Throttled an Agency Devoted to the Safety of American Healthcare,” by Arthur Allen.

• The Washington Post’s “Peptide Boom Has States Scrambling To Protect Consumers, Post Investigation Finds,” by Lauren Weber.

• Politico’s “Activists ‘Throwing Everything’ They Can Against Abortion Turn to Wastewater Data,” by Alice Miranda Ollstein and Ariel Wittenberg.

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The big thing driving health care costs as an issue is voters’ worries about getting hit with big health care bills. That makes sense. Only 1 in 10 people are hospitalized each year but far more worry about incurring major medical bills if they get sick. Health care costs provoke special anxiety because they are less predictable than other household expenses. On the other hand, everyone has to buy food and gas (except a few of us EV owners) and pay their monthly housing costs, and people have a pretty good fix on what those costs are. This is why people are upset about drug prices, too—it’s the health cost they see almost as often as they pay for food or pay the rent. Two thirds of adults take a prescription drug and 3 in 10 take four or more.

You can see this in our polling:

• In June, we asked voters: “How WORRRIED [my emphasis] are you about being able to afford each of the following for you and your family,” and gave them a list to choose from including health care costs, gas, rent and mortgage, food, utilities, and so forth. Health care costs were clearly the number one worry, as we reported at the time, followed by gas and rent and the mortgage, but worries about everything were reasonably closely clumped together:

Gallup asked a similar worries question and got a similar result: the “availability and cost of health care” was the public’s top worry, followed by the economy and inflation.

• On other hand, in late spring, CNN asked voters to say in their own words what “the biggest economic PROBLEM [my emphasis] was facing their family.” General cost of living was named most often, with food, gas and housing well ahead of health costs. People see these costs more frequently but may worry about them less than they do a big health care bill. However, when gas prices and food costs or housing costs rise, it can also make it tougher for families to pay their health care bills, underscoring that a family budget is made up of interconnected parts and a bottom line, even as pollsters often try to rank them on a scorecard.

• We also asked a different question in our polls: What issues do you want to hear the candidates talk about in health? Health care costs emerged as number one, followed by the future of Medicare, fraud in government health programs, and then the future of Medicaid.

Why does this matter?

First, be alert that the various polls are asking different things about health care when you see issue rankings: worries, problems facing people, problems facing the nation or for government to address, and what candidates should be talking about, are all different things that will get different answers and rankings from the public.

Second, both worries about unexpected health care costs and problems paying health care bills are motivating voter concern about health care. For candidates, appealing to worries is likely the smarter course that broadens the net of concerned voters.

Finally, voters clump health costs with a series of other problems and worries about their family budgets. I have come to the conclusion that the search for a single top issue through polling questions—whether it’s health costs, or gas prices, or the cost of food—is artificial. People worry about and experience these costs together. There is no top issue, unless that issue is the catchall, “cost of living.”

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The demonstration provided extra subsidies to PDP plan sponsors, and by extension PDP enrollees, in two ways – reducing the base beneficiary premium, which is used in the calculation of individual plan premiums, and capping the year-over-year increase in the monthly premium. In 2025, the demonstration’s first year, the base beneficiary premium was reduced by $15, and the monthly premium increase was limited to $35. For 2026, these parameters were scaled back, with a base premium reduction of $10 and a maximum allowable premium increase of $50.

Without these extra subsidies in place for 2027, some Part D stand-alone drug plan enrollees could face a larger premium increase for drug coverage next year than in recent years, though plan-specific premium amounts are not yet known. While some policymakers questioned the rationale for and cost of the premium stabilization demonstration, which totaled $9.8 billion in 2025 and 2026, the extra subsidies worked as intended to stabilize year-over-year PDP premium increases and prevent substantial PDP enrollment changes. Premium subsidies provided under the demonstration reduced the average monthly PDP premium by $26 in 2025 and $16 in 2026, according to MedPAC, while PDP enrollment increased from 22.8 million in 2024 to 24.9 million in 2026.

Even with these subsidies in place, however, the average monthly PDP premium in 2026 is more than 4 times higher than the average premium for drug coverage in Medicare Advantage plans ($36 vs. $8), with MA-PD sponsors able to use rebates to buy down drug coverage premiums. And while the subsidies provided to PDP sponsors under the temporary demonstration may have helped cushion the impact of IRA-related cost increases, they didn’t address broader cost pressures facing Part D plan sponsors associated with rising drug prices and increasing use of GLP-1s and expensive specialty drugs. These cost pressures are likely to continue in 2027 and beyond.

Juliette Cubanski
Vice President and Director of the Program on Medicare Policy

The ACA opened the door to comprehensive coverage for tens of millions who didn’t have that option before. In 2025, Marketplace enrollment hit an all time high of more than 24 million.

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, Senior Vice President and Director, Program on the ACA and Peterson-KFF Health System Tracker, looks at the ACA’s record and the broader underlying question it raises: what’s a fair price to pay for health care?

Video Transcript

The Affordable Care Act has been criticized for not living up to its name. But has it actually failed on affordability?

National health spending has been on the rise in recent years, driven by the increasing cost of hospital care, physician and clinical services, and prescription drugs.

But looking back to the decade after the ACA, annual spending grew markedly slower.

Dropping from average increases of 10 to 12 percent a year in the 1970s and 80s to around 4 percent in the 2010s.

It’s hard to prove that the ACA restrained spending, but there’s no evidence it accelerated growth even while helping to bring down the rates of the uninsured by providing coverage for millions more people.

The ACA allowed states to expand Medicaid to cover more low income individuals. It also created new Marketplaces where people without coverage through a job or other sources could buy their own insurance.

Now, the self-employed, small business owners, those between jobs or working without benefits, retirees not yet eligible for Medicare, can buy a comprehensive plan comparable to most employer-sponsored insurance.

The ACA also set new insurance regulations, among the most significant of which was prohibiting insurers from charging more or denying coverage based on a pre-existing health condition.

It also established a list of essential health benefits that insurance must offer without lifetime or annual limits.

Importantly, the ACA’s individual market has similar average premiums as employer-sponsored plans.

While employers offset the high cost of health insurance for workers, under the ACA, the federal government provides tax credits based on income to make self-purchased coverage more affordable.

Even with these tax credits, the ACA faced criticism about not being affordable enough.

In 2021, Congress temporarily enhanced the ACA’s premium tax credits, and then extended them through 2025 as part of the Inflation Reduction Act, lowering out-of-pocket premium payments across the board for enrollees.

With coverage more affordable, Marketplace enrollment hit record highs.

The expiration of the enhanced premium tax credits at the end of 2025, combined with insurers charging more for coverage, means ACA Marketplace enrollees are facing higher costs this year.

On average, up 58 percent, or about $780 more than last year.

To offset the higher costs, many switched to lower premium plans. But that comes with a tradeoff: higher deductibles.

A KFF survey of ACA Marketplace enrollees found 3 in 10 switched plans in 2026, the large majority citing cost. Another 1in 10 dropped coverage altogether and are now uninsured.

While the expiration of the ACA’s enhanced premium tax credits has raised affordability concerns for many enrollees, the underlying question it raises is a wider reaching one:

What is an affordable level of health care costs that people should be expected to bear?

Watch and share the full series. Available on YouTube.

KFF encourages linking to and reposting of our content on social media and other digital platforms.

Enrollment in the federal food stamp program — the Supplemental Nutrition Assistance Program, known as SNAP — is down by more than 10% nationally, according to a new report, and in some states by as much as half. Those numbers are falling as states enact changes ordered by the GOP budget bill passed in 2025. The drop is much steeper than was predicted and could portend a similar fate for those on Medicaid, as states prepare to implement many of the same changes ordered for SNAP.

Meanwhile, amid a rise in reported cases of the gastrointestinal ailment caused by the parasite cyclospora, federal public health officials once again struggle to explain to a confused populace how to stay safe.

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Among the takeaways from this week’s episode:

• Participation in the nation’s food stamp program is down, with children representing nearly half of those losing benefits, according to a recent analysis. Some states are showing much larger drops than others. The GOP-passed budget law imposes penalties for errors, leaving states spooked about the possibility of losing funding — and suggesting problems ahead for the full rollout of Medicaid work requirements next year.

• President Donald Trump’s immigration crackdown is increasing pressure on the health system, in particular on the availability of home-based and long-term care workers — including those who fill critical roles such as serving food and driving patients to medical appointments. Research has shown that the presence of immigrant workers has a protective effect on the health of their charges.

• Responding to revelations that doctors are reaping large payouts from the surprise-billing arbitration process, the Trump administration this week released information showing a spike in such payments and noted the need for changes to the law — without specifying what kind of changes. That law, the No Surprises Act, took effect in 2022 with the primary intention of shielding patients from big bills when they unknowingly receive out-of-network medical care.

• In other news, the Pentagon is imposing testosterone tests for many service members. The cyclospora outbreak continues. And the Trump administration announced plans to withhold Medicaid funding from California and Minnesota over accusations of fraud.

Also this week, Rovner interviews Sen. Bill Cassidy (R-La.), chairman of the Senate Health, Education, Labor, and Pensions Committee, as part of the “How Would You Fix It?” series.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The New York Times’ “The Fake Influencers Selling Wellness on Your Feed,” by Arijeta Lajka, Isabelle Niu, Mark Boyer, James Surdam and Dan T. Peters.

Joanne Kenen: Stat’s “A Most-Wanted Fugitive Appears To Have Been Secretly Working as a Biotech Executive,” by Adam Feuerstein.

Margot Sanger-Katz: NPR’s “Amid Nurse Shortage, a University Rolls Out the Welcome Mat for Men,” by Andrea Hsu.

Alice Miranda Ollstein: Roll Call’s “Trump Administration Puts Kibosh on HIV Prevention Funding,” by Ariel Cohen.

Also mentioned in this week’s podcast:

• KFF Health News’ “Doctors ‘Cringe’ at Possibility of Documenting Which Medicaid Enrollees Too Sick To Work,” by Sam Whitehead.

• KFF Health News’ “A Deloitte-Run System Denied Medicaid Benefits for Michigan’s Disabled. Now Trump’s Law Piles On,” by Rachana Pradhan, Samantha Liss, and Kate Wells.

• The New York Times’ “Senior Living Facility in Distress as Immigrant Caregivers Are Forced Out,” by Miriam Jordan.

• The Wall Street Journal’s “Medical Billing Arbitration Paid Out $15 Billion to Providers in Surprise Bill Disputes,” by Anna Wilde Mathews and Tom McGinty.

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Some social media posts have claimed that Taylor Farms’ political donations and its executives’ meetings with White House and FDA officials shaped the FDA’s decision to retract the test result. There is no confirmed evidence for that, and HHS has denied any political influence, saying the agency’s decisions are guided only by science and public safety.

The skepticism surrounding the FDA’s retraction of a positive test tying Taylor Farms lettuce to the cyclosporiasis outbreak comes at a time of broader public distrust in the agency. KFF’s April 2026 Health Tracking Poll found that just over a third (36%) of adults are confident in the FDA to act independently without interference from outside interests, including similarly low shares across partisans. Recent KFF polling also shows that about half of Americans have at least a fair amount of trust in the FDA for reliable health information, while the other half express little to no trust. These dynamics illustrate how unsubstantiated claims can circulate alongside a factual correction, particularly in a period when confidence in federal health agencies is eroding.

Making factual corrections is a routine part of how science and public health work, since findings often get revised as more evidence comes in. But doing so in an environment where trust in these institutions is already limited adds a layer of difficulty. How to explain a correction clearly enough to hold up against public skepticism, particularly when investigations are still underway and full details may not yet be available, is a recurring question for science and public health communicators operating in this environment.

Hagere Yilma
Senior Manager, Health Information and Trust

For decades, the cost of medical care, prescription drugs and health insurance has consistently risen faster than general inflation and wage growth, posing financial challenges for government, businesses and people. KFF polling has found that the cost of health care ranks as the top economic worry for adults and their families, and has implications for their financial security and access to care. Even people with insurance say they struggle to afford health care costs, and health care debt is a burden for a large share of Americans. Policymakers and experts across the ideological spectrum define affordability in different ways and have different policy solutions.

On Tuesday, July 21, three experts joined Health Wonk Shop series moderator Larry Levitt for an hour-long discussion of health care affordability. During the discussion, the panelists considered affordability from a variety of perspectives, including how to define affordability, the question of affordability for whom, how to measure it, and what can be done to address affordability and the underlying cost of health care.

Moderator

• Larry Levitt, Executive Vice President for Health Policy

Panelists

• Sherry Glied, Professor of Public Service, New York University’s Robert F. Wagner Graduate School of Public Service

• Benedic Ippolito, Senior Fellow in Economic Policy Studies, American Enterprise Institute

• Ashley Kirzinger, Director of Survey Methodology, Associate Director for Public Opinion and Survey Research

Episode 13, AI Series: AI is racing into everyday medicine. The rules of the road are still being written. Dr. Michelle Mello of Stanford, professor at both the Law School and the School of Medicine, and co-leader of its Healthcare Ethical Assessment Lab for AI, joins Chip to address the questions that trail every advance this series has covered: who makes the rules, who ensures the technology gets it right — and who answers when it doesn’t?

About the Podcast

This weekly podcast features insightful conversations between host Chip Kahn and his guests, who discuss the business of health care, connecting the dots between the health care business, policy, and patients.

The podcast’s first series on AI in health care illuminates how AI is changing health care, and features guests who are deploying this technology, managing its consequences, and designing policy around it.

This is the third in my series about the most innovative things we have done over the years at KFF. One big takeaway from these KFF history columns: we keep changing; we don’t always continue what we’ve been doing if the job is done, or it no longer meets a need or an organizational objective. That was the case with one of our most ambitious but relatively short-term efforts—the Global Media AIDS Initiative.

In 2004, in partnership with the United Nations (U.N.) and UNAIDS, we launched the Global Media AIDS Initiative, with regional HIV awareness and prevention media campaigns all over the world.

It was a time when the world was seeking scalable, non-clinical efforts to complement treatment expansion and prevention programs. We saw an opening to add our expertise in media and the experience that we had gained operating large-scale HIV campaigns in South Africa and in partnerships with the largest media companies in the U.S. to the global HIV effort. UNAIDS was interested in co-sponsoring the effort.

U.N. Secretary-General Kofi Annan, UNAIDS head Dr. Peter Piot, Bill Gates and I convened a media “summit” at the U.N. and invited the heads of media corporations and organizations from around the world to attend. I had no idea if they would show up in New York but apparently feeling like they were being treated much like heads of state by being invited to the U.N. by the Secretary General, the interest was overwhelming from global media leaders and executives.

At the summit, no media leader wanted to make a smaller commitment than others made, and like a PTA auction, escalating commitments of media time and content were made. That was the case even for media executives from Russia where HIV, which was mostly an injection drug use epidemic there, had been criminalized and wasn’t discussed. Fortuitously, President Putin was about to host what was then the G8, and wanted to look like a good guy. Putin called the head of Gazprom media out of the meeting to convey the message when he returned that Russia would make big commitments in media time and content to what became known as Stop Spid (Stop AIDS ) in Russia.

We asked the media companies and organizations to make these commitments:

• Designate the fight against HIV/AIDS as an overall corporate priority;

• Commit substantial time and/or space to the issue, including programming/editorial and advertising;

• Provide current news coverage of the epidemic, both globally and locally;

• Support efforts to train reporters and producers to cover the epidemic;

• Support the development and broadcast of HIV/AIDS-related shows, films, and documentaries;

• Encourage the integration of HIV/AIDS-themes in storylines;

• Make content addressing HIV/AIDS available rights-free to other outlets; and,

• Provide comprehensive workforce education efforts about HIV.

Media organizations in several regions committed 5% of their prime-time programming to HIV content. Our job was to scramble around the world and build partnerships with credible organizations that were involved in each region to make all these things happen, launching real campaigns before the media leaders forgot about the summit commitments.

Campaigns were born all over the world. The most significant were: the Caribbean Broadcast Media Partnership on HIV AIDS and its “Live Up” campaign, led from Barbados by my friend Allyson Leacock; the African Broadcast Media Partnership Against HIV/AIDs and “Imagine Africa,” organized by our South Africa program director Michael Sinclair; the Russian Media Partnership to Combat HIV/AIDS and “Stop Spid,” led by KFF staff and an organization called TPAA (the Transatlantic Partnership Against AIDS), whose key vice president we eventually hired; the Latin American AIDS Initiative; and the Asia-Pacific Media AIDS Initiative. We also coordinated our large-scale U.S. based campaigns, which were with companies such as Viacom, Fox, MTV and BET, with the global campaigns. I will write about the domestic efforts separately. The overall effort was directed by our talented Senior Vice President Tina Hoff, who led our domestic media campaigns.

One thing that immediately became clear was that one strategy and one message would not work globally. In the Caribbean, the main issue was stigma, and campaign messaging was aimed at that. Barbados had a uniquely impressive approach. In addition to media messaging, Barbados staged large-scale community festivals where grandparents and parents and kids would come to be tested for HIV together while enjoying food, music and the day together. Everybody got tested together, which reduced if not eliminated any stigma. We often do not apply practices from other countries in health, and I wondered if that could work in communities here.

In Russia, the goal was simply to break the silence on HIV, which previously couldn’t be publicly discussed. Stop Spid helped achieve that. The Russians hated the generally empowering messaging that we favored around the world and requested downbeat, if not dour messaging, instead, which worked well in Russia. Here’s an example:

In Africa, the challenge was to refresh an AIDS message that Africans had been hearing over and over. We chose an upbeat theme that looked beyond HIV to a brighter future—imagining an Africa without HIV. HIV was entrenched in Africa, and messaging also had to be targeted to be effective.

In India, we worked with the Heroes Project, championed by Richard Gere and the government, and built our messaging off of cricket stars and outlandish Bollywood characters. Here’s one example:

Only some of the substantial messaging and creative material developed over the years in our campaigns with U.S. partners proved useful in other countries and cultures, even though the work garnered seven Emmy and two Peabody awards. But it did give us the experience base we needed to bring to the global work, as did our very large loveLife campaign in South Africa. We became adept at developing messaging and creative content. Here’s one example of one of our Emmy-winning U.S. messages that gave us “street cred” in the field:

Of course, not every country proved welcoming. The Dominican Republic was a tough sell, as was Cuba, as we expected it to be. China and CTV were mostly impenetrable although some media from Hong Kong made its way into mainland China.

After about five years, the media companies and organizations had sustained special high-intensity commitments to HIV for about as long as it was reasonable to expect, and we dialed back, and eventually discontinued, our involvement. However, in some regions, notably the Caribbean, efforts were continued by partners for much longer, and in some cases, campaigns evolved under other auspices. Sustained funding for media campaigns on public health issues from UNAIDS and every global funder has always been an issue, and it was in this case, too. Of course, we knew that media by itself was not the answer to HIV, but we also knew it was an indispensable element of an overall global effort and an area where we could make a special contribution. Our objectives had largely been achieved, adding a substantial media component to the global fight against HIV when there was an opportunity to do so.

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View all of Drew’s Beyond the Data Columns

When Republicans passed their big budget bill in 2025, they scheduled many of the Medicaid reductions to take effect in 2027, after the 2026 midterm elections. But in anticipation of getting less money from Washington come January, many states are already cutting their Medicaid programs, making the issue more relevant for voters in November.

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Among the takeaways from this week’s episode:

• Congress has no clear path to passing its annual spending bills, with the issue of Medicaid funding for Planned Parenthood again threatening to gum up the works. Meanwhile, senators this week screened President Donald Trump’s newest health nominees: Erica Schwartz to lead the Centers for Disease Control and Prevention and Sean Kaufman to lead the Administration for Strategic Preparedness and Response. But Schwartz undermined some senators’ confidence by claiming ignorance about a number of Trump administration funding cuts, and Kaufman faced fiery questions over a deleted social media post about the hepatitis B vaccine.

• The confirmation hearing for Todd Blanche as attorney general also trod into health territory, with Blanche saying he would review potentially using the 19th-century Comstock Act to block distribution of medication abortion drugs by mail. Such a move could block not only mifepristone but also misoprostol, which is the second abortion medication in the two-drug regimen — and is also used for non-abortion purposes. Trump promised on the campaign trail not to invoke the Comstock Act.

• In politics, Maine Democrats are cautiously eying the abortion stances of a replacement Senate candidate, hoping to pin the rollback of abortion rights on Sen. Susan Collins, the Republican incumbent. And Sen. Ron Wyden (D-Ore.) is calling for an investigation into whether Health and Human Services Secretary Robert F. Kennedy Jr. violated a federal law aimed at preventing electioneering by officials when he made recent calls to persuade some candidates to drop out of congressional races.

• And the gastrointestinal infection cyclosporiasis is sickening more Americans and drawing attention to the Trump administration’s actions undermining food safety surveillance programs. The cyclospora parasite was once subject to mandatory reporting but has since been made voluntary, challenging efforts to track the source and contain the outbreak.

Also this week, Rovner interviews Elizabeth Mitchell of the Purchaser Business Group on Health as part of the “How Would You Fix It?” series.

Plus, for “extra credit” the panelists this week suggest health policy stories they read (or wrote) that they think you should read, too:

Julie Rovner: Mississippi Today’s “Mississippi Is Getting Hotter. Experts Say It’s Hurting Moms and Babies,” by Sophia Paffenroth and Joanne Kenen.

Anna Edney: Bloomberg News’ “Almost $1 Billion Later, the US Still Can’t Make a Medical Glove,” by Anna Edney.

Alice Miranda Ollstein: Politico’s “Fraud Investigations Are Crumbling This State’s Medicaid System,” by Amanda Chu and Robert King.

Sandhya Raman: Bloomberg Law’s “Unverified GLP-1-Related Claims Flood Food, Supplement Markets,” by Nyah Phengsitthy and Skye Witley.

Also mentioned in this week’s podcast:

• Stat’s “As States Absorb Medicaid Funding Cuts, Family Caregivers Face Financial Ruin,” by O. Rose Broderick.

• NPR’s “Trump’s HHS Shelves Threat To Withhold Medicare and Medicaid Funding Over Trans Care,” by Selina Simmons-Duffin.

• Stat’s “Flood of Comments on White House Grantmaking Overhaul Is Largely Negative, Analysis Shows,” by Anil Oza and J. Emory Parker.

• Politico’s “Trump Admin Asks Appeals Court To Roll Back Obamacare’s Contraception Coverage,” by Alice Miranda Ollstein.

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While employers bear most of that burden, workers also feel the pressure in the premium deductions in every paycheck and higher deductibles.

The total premium for a family plan now averages $27,000 a year, according to KFF’s latest annual Employer Health Benefits Survey. That’s enough to buy a new Toyota Corolla Hybrid. Every. Single. Year.

KFF’s Matt Rae, Associate Director of the Program on the Health Care Marketplace, unpacks the full cost of employer-sponsored insurance and why that may be the bigger health care affordability story hiding in plain sight.

Video Transcript

More people get health coverage through an employer than from any other source. That’s 154 million Americans under the age of 65.

The debate over the Affordable Care Act’s expiring enhanced premium tax credits put health care affordability in the national spotlight.

But the issue doesn’t stop with Marketplace enrollees.

In the 2026 midterm election year, the cost of health care is a top economic worry for voters.

And for good reason. The costs add up.

People who get health insurance through an employer typically see a deduction in every paycheck for their share of the premium.

Workers contributed on average $6,850 towards the cost of a family premium in 2025. And, $1,440 for single coverage.

And those payments are just the starting cost.

Most workers also have a deductible that must be met before insurance starts paying for most services.

Workers at smaller companies, those with fewer than 200 employees, typically face higher out-of-pocket deductibles than those at larger companies.

As substantial as those out-of-pocket costs are, the true price tag of health insurance is largely shielded from workers through employer contributions, which on average cover about three quarters of the total premium.

The total annual cost for a family plan, including both worker and employer premium contributions, has been steadily rising, now averaging about $27,000 a year. Up 26% from five years before.

That’s enough to buy a new Toyota Corolla Hybrid. Every. Single. Year.

Rising premiums are straining both workers and employers.

The average annual earnings of a full-time worker was about $62,000. That puts the full cost of a family health insurance premium at over 40% of the typical salary.

Employers single out drug prices as a contributing factor, especially the widely popular and effective GLP-1 medication for diabetes and weight loss.

Add in rising hospital costs and a growing burden of chronic illness and the pressure isn’t letting up anytime soon.

Employer-sponsored insurance is a cornerstone of how Americans access health care. Understanding its full cost and what’s driving it higher matters for workers, employers, and policymakers alike.

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