Health Issues

Data sources used for Key Facts About Hospitals are listed below. Some figures pull from other sources, including prior KFF analyses and KFF State Health Facts, which include additional information about the data and methodology. Numbers have been rounded.

American Hospital Association (AHA) Annual Survey. Data from an annual survey of all hospitals in the United States and its associated areas. Non-federal psychiatric hospitals were defined to include psychiatric hospitals as well as hospitals that identified their hospital type as “substance use disorder” or “intellectual disabilities.”

American Medical Association (AMA) Physician Practice Benchmark Survey. As described by the AMA, the Physician Practice Benchmark Survey is a nationally representative survey of “post-residency physicians who provide at least 20 hours of patient care per week, are not employed by the federal government, and practice in one of the 50 states or [DC].”

Census Bureau delineation files. The Census Bureau delineation files map counties and county equivalents to metropolitan areas, micropolitan areas, and other regions. These files were used to group hospitals into metropolitan, micropolitan, and other areas. A metropolitan area is a county or group of counties that contains at least one urban area with a population of 50,000 or more people. A micropolitan area is a county or group of counties that contains at least one urban area with a population of at least 10,000 but less than 50,000. Urban and rural regions were defined as metropolitan and nonmetropolitan areas, respectively.

Census Bureau population estimates. We relied on annual population estimates for the 50 states and DC as of July 1 of a given year from the Census Bureau’s Population Estimates Program.

Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS). The NIS is a sample that includes about 20% of all inpatient discharges from U.S. community hospitals (aside from rehabilitation and long-term care hospitals). It is nationally representative of non-federal short-term hospitals in the U.S. and is sponsored by the Agency for Healthcare Research and Quality. Primary diagnoses are grouped into clinical categories based on Clinical Classifications Software Refined (CCSR). The categories used for rankings are mutually exclusive; when a diagnosis falls under multiple clinical categories, the stay is assigned to a single category based on hierarchical guidelines.

KFF Health Care Debt Survey. The KFF Health Care Debt Survey is a nationally representative survey of U.S. adults that was conducted from February 25 through March 20, 2022.

Medical Expenditures Panel Survey (MEPS). MEPS is a nationally representative survey of the U.S. civilian non-institutionalized population that includes information about health care expenditures and sources of payment, among other things. The analysis of out-of-pocket spending relied on the MEPS Household Component (HC).

National Health Expenditures. These data are published annually by the Centers for Medicare & Medicaid Services and provide estimates of national spending on health care, by payer and by type of service.

Producer Price Index (PPI). These data come from the Bureau of Labor Statistics (BLS). As BLS notes, PPI indices measure “the average change over time in selling prices received by domestic producers of goods and services.” The health care PPIs reflect the reimbursement that providers receive for health care services. The Medicare, Medicaid, and private and other patient PPIs are mutually exclusive. The Medicare and Medicaid PPIs take account of private Medicare and Medicaid plans. The PPI may exclude supplemental payments that are paid to hospitals as a lump sum.

Quarterly Census of Wages and Employment (QCEW). These data also come from BLS. As BLS notes, the QCEW data provide a “quarterly count of employment and wages reported by employers covering more than 95 percent of U.S. jobs.” The QCEW includes workers covered by state unemployment insurance laws as well as federal workers covered by the Unemployment Compensation for Federal Employees (UCFE) program. Analyses of hospital and other employment relied on the average annual employment numbers reported by BLS. Industry subsector rankings were based on 3-digit NAICS codes. Employment for a given industry subsector and employer type were not included in totals when not disclosed by BLS.  

RAND Hospital Data. These data are a cleaned and processed version of annual cost reports that Medicare-certified hospitals are required to submit to the federal government. Cost reports include information about hospital characteristics, utilization, and finances. The RAND Hospital Data also crosswalk hospitals to health systems based on the Agency for Healthcare Research and Quality (AHRQ) Compendium of U.S. Health Systems.

For charity care analyses, missing charity care costs were recoded as $0 if the hospital reported total unreimbursed and uncompensated care costs. Hospitals were excluded if they had missing or negative operating expenses or charity care costs, outlier amounts of charity care as a percent of operating expenses (≥18.1%), or reporting periods less than or greater than one year. Cost report instructions indicate that hospitals should report amounts related to both charity care and uninsured discounts as part of their charity care costs. MedPAC has noted that current HCRIS calculations favor hospitals with higher markups, and it has recommended revisions that would put hospitals on more equal footing and reduce reported charity care costs on average.

RAND Price Transparency Study, Round 5.1. These data are based on commercial claims for employer-sponsored health insurance plan enrollees collected from participating self-insured employers and health plans as well as from all-payer claims databases (APCDs) from 12 states. Commercial-to-Medicare price ratios are based on the actual allowed amount from the claims and an estimate of the allowed amount had Medicare covered the same services. Ratios presented in key facts include facility claims for hospital inpatient and outpatient services but exclude associated professional claims (which are also available through the RAND study). Analyses of metropolitan areas exclude hospitals for which RAND did not disclose relevant data while state and national analyses include all hospitals in the RAND study.

Survey of Income and Program Participation (SIPP). SIPP is a nationally representative survey of the civilian noninstitutionalized population. Among other questions, SIPP asks individuals ages 15 and older about their medical debt. The analysis of medical debt further restricted the sample to adults ages 18 and older.

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Americans’ life expectancy is significantly lower than the average for people in other large, wealthy countries.

This analysis compares 2021 data about deaths in the U.S. and 11 other large, wealthy countries by age and cause to understand the primary drivers of the longevity gap between the U.S. and the comparable countries. It finds that the primary reasons for the gap in 2021 were chronic disease, COVID-19 and substance use disorders.

The analysis is available through the Peterson-KFF Health System Tracker, an information hub dedicated to monitoring and assessing the performance of the U.S. health system.

KFF’s January 2025 Prescription Drug Advertisements Poll looks at the public’s experiences with prescription drug advertisements. The poll measures the share of adults who report seeing such advertisements, as well as how these drug advertisements influence the care the public reports receiving from their doctor or health care provider.

Enhanced Affordable Care Act (ACA) subsidies were first made available as part of the American Rescue Plan Act in 2021 and were extended through the end of 2025 by the Inflation Reduction Act. The enhanced subsidies build on the ACA’s original tax credits by increasing the amount of premium assistance lower-income enrollees receive, and by making middle- and higher-income enrollees (with incomes over four times poverty) newly eligible for financial assistance to buy health insurance. These enhanced subsidies will expire at the end of this year unless Congress further extends them and President Trump signs it into law. In 2024, 56% of ACA Marketplace enrollees live Congressional Districts represented by Republicans and 76% of enrollees are in states won by President Trump in the 2024 election.

If the enhanced subsidies expire, monthly premium payments for the vast majority of Marketplace enrollees will increase sharply starting January 1, 2026. Among subsidized enrollees living in states that use Healthcare.gov (where data are available), premium payments would have been an average of 93% higher in 2024 without the enhanced tax credits. If these enhanced subsidies expire, the Congressional Budget Office (CBO) projects that there will be an average of 3.8 million more uninsured people each year. Unsubsidized premiums will also likely rise as healthier enrollees drop their coverage. While some state-based Marketplaces offer additional premium financial assistance for certain enrollees, the amount of and availability of these state subsidies would not be enough to fully replace the federal enhanced subsidies.

The interactive map below illustrates how much premium payments would rise without the enhanced subsidies, net of tax credits, at the congressional district level. The tool presents average net premium increases (for states that use Healthcare.gov, where data are available) and two hypothetical scenarios (in all states): one of an older couple who would lose subsidy eligibility due to their income exceeding four times poverty and another for a single individual with a $31,000 income (206% of poverty). A KFF calculator allows users to evaluate zip-code specific changes in premium payments with and without enhanced subsidies for other income and family scenarios.

Because enhanced tax credits decrease premium payments across the board for people receiving a tax credit, all subsidized Marketplace enrollees will experience increases in their monthly premium payments if the enhanced subsidies expire. However, how much each enrollee’s premium payment increases will vary widely and will depend on their family size, location, and income.

Average Increases in Premium Payments Among Subsidized ACA Enrollees

In some congressional districts, there is both a large share of the population enrolled in ACA Marketplace coverage and an expectation of very high average increases in premium payments without the enhanced tax credits. Among states that use Healthcare.gov (where average enhanced tax credit data are available), there are 39 congressional districts where at least 10% of the population is enrolled in the ACA Marketplaces and where 2024 average premium payments would have been double or more had it not been for the enhanced subsidies (Table 1). While these 39 districts are politically split (19 are represented by Democrats and 20 are represented by Republicans), these districts are mostly concentrated in a few red states. Twenty of these 39 districts are in Texas, 7 are in Florida, and 3 are in Georgia. These states are among those that have seen ACA Marketplace enrollment grow the most since the enhanced subsidies went into effect. Since 2020, ACA Marketplace enrollment has more than doubled in Florida and more than tripled in Texas and Georgia.

Increases in Premium Payments for An Older Couple on the “Subsidy Cliff”

The expiration of the enhanced premium tax credits would mean that people with incomes over four times the poverty level are no longer eligible for financial assistance. Prior to the availability of enhanced subsidies, ACA Marketplace premium assistance eligibility capped at 400% of poverty (which is $60,240 for a single person or $81,760 for a couple in 2025). If enhanced subsidies expire, Marketplace enrollees making just above 400% of poverty will encounter the “subsidy cliff” and would face the full price of a Marketplace plan. If the enhanced subsidies expire, a 60-year-old couple making $82,000 (401% of poverty) would see their premium payment for the benchmark silver plan, on average, at least double in the vast majority of congressional districts. The benchmark silver premium for a 60-year-old couple at this income would triple or more, on average, in 328 congressional districts.

Premium Increases for Lower-Income Enrollees

A 40-year-old Marketplace enrollee in the contiguous U.S. making $31,000 (206% of poverty) would see monthly premium payments in 2025 rise by $95 (a 165% increase) from $58 to $153. (Alaska and Hawaii have different poverty guidelines). Nationally, there are 75 congressional districts where at least 10% of the population is enrolled in the Marketplace. For a 40-year-old making $31,000, premium payments would at least double on average in all 75 districts. 62 of these districts are in Florida, Georgia and Texas. 38 of these 62 districts are represented by Republicans while 24 are represented by Democrats.

Under the enhanced phase out caps, Marketplace enrollees with incomes up to 150% of poverty currently pay zero (or near zero) dollars for a benchmark silver plan. Should the enhanced subsidies expire, enrollees in this income group will be on the hook for some of the cost of their premiums if they want to keep a silver plan. Before the enhanced subsidies went into effect, Marketplace enrollees at this income group paid about 2-4% of their income for a benchmark plan. A sizeable portion of the Marketplace population benefits from zero dollar premiums, with 42% of HealthCare.gov enrollees in 2024 paying nothing for Marketplace coverage (up from 14% of HealthCare.gov enrollees in 2021).

On Friday January 31, 2025, several federal government datasets went offline. The datasets taken down included some widely used, large-scale national health surveys, indices, and data dashboards that inform research, policy making, and media coverage about health care and public health. For example, several Centers for Disease Control and Prevention (CDC) surveys and datasets were offline Friday and Saturday, with messages simply saying the page “was not found.” The homepage of the United States Census displayed an error message, but data.census.gov – where many datasets can be downloaded – was functioning.

By Sunday February 2, 2025, some of the landing pages started to come back online – now with a warning message: “CDC’s website is being modified to comply with President Trump’s Executive Orders,” suggesting there could be future changes. In some cases, survey data files are back online and appear to be intact, but the survey documentation (questionnaires and codebooks), which researchers use to analyze the data files, remained offline. Some related reports also remained offline. It is not yet clear whether all the datasets and their documentation that went offline will come back or remain online, and if they do, what changes, if any, will be made. It also remains to be seen what changes may be made to future data collection efforts.

The removal or modification of these data sources appears to be in response to executive orders issued by President Trump on his first day in office outlining the administration’s perspectives and approach to sex and gender and on racial equity and diversity equity and inclusion (DEI), as well as a pause on foreign assistance. An Office of Personnel Management (OPM) memorandum on the first EO directed departments and agencies to “take down all outward facing media (websites, social media accounts, etc.) that inculcate or promote gender ideology” and “withdraw any final or pending documents, directives, orders, regulations, materials, forms, communications, statements, and plans that inculcate or promote gender ideology.” Another OPM memorandum similarly directed departments and agencies to “Take down all outward facing media (websites, social media accounts, etc.) of DEIA offices”. None of these executive orders nor the OPM memos specifically mention datasets or survey data.

Federal surveys play a key role in the health surveillance system, which helps direct initiatives to address some of the most pressing health conditions and problems facing the country. For example, one of the affected datasets is CDC’s Behavioral Risk Factor Surveillance System (BRFSS), which is one of the most widely used national health surveys and has been ongoing for about 40 years. Datafiles for all years were temporarily offline and as of this writing have been reposted, but without questionnaires or codebooks. BRFSS is described on one federal website as a source of state-level “information about health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury.” The survey has been used for decades to inform policymakers, the media, and the public on a wide range of health topics, such as obesity rates, access to breast cancer screenings, vaccination rates, and the share of people with pre-existing conditions. With sampling in every state, BRFSS data are particularly helpful for understanding health issues in low-population states and rural areas.

In reviewing KFF’s archives of the BRFSS core questionnaire, it did not include detailed questions about sexual orientation or gender identity. However, in recent years, BRFSS offered an optional module on sexual orientation and gender identity, which was implemented in most states. This supplemental data has been used by KFF to show that adults who identify as transgender are more likely than cisgender adults to be uninsured, experience depression, and report being in poor health. At the time of this writing, the BRFSS data file is back online and appears to be intact, including the question about gender identity, though the survey documentation is not online.

Another of the datasets taken offline was CDC’s Youth Risk Behavior Survey (YRBS), which, since 1990, has tracked high school students’ behaviors that can influence health and social outcomes, like smoking, drug and alcohol use, and dietary and exercise habits. Like BRFSS, the landing page and associated materials were offline but, as of the time of this writing, have returned without questionnaires or codebooks. This survey is particularly useful because it asks questions to teenagers directly, rather than surveying their parents, who may be unable or unwilling to answer questions accurately. KFF analysis of YRBS data has shown that large shares of teenagers experience persistent sadness and hopelessness, and that teenage girls experienced a sharp rise in suicidal ideation during the pandemic. Recently, the YRBS has asked respondents about their sexual orientation and gender identity, and the data has been used to highlight substantial mental health disparities among LGBTQ+ high school students, compared to their non-LGBTQ+ peers.

Several of the other datasets taken down (at least temporarily) relate to HIV/AIDS in the U.S. as well as global health efforts around the world in low and middle-income countries, including but not limited to:

• CDC AtlasPlus: an interactive database with about 15 years of surveillance data for HIV, viral hepatitis, STD, and TB, as well as data on the social determinants of health. (Data pertaining to the Ryan White HIV/AIDS Program also remain offline as of this writing, including reports and databases.)
• PEPFAR Data Dashboards: PEPFAR, the U.S. global HIV/AIDS Program’s comprehensive, up-to-date online data portal of program budgets and expenditures by country and service category, among other variables.
• Demographic and Health Surveys (DHS) databases: an ongoing set of nationally representative household surveys with population, health, HIV, and nutrition data from more than 90 countries, data downloads.
• Foreignassitance.gov: The U.S. government’s website with all foreign assistance data by country, budget, expenditure, program, going back more than two decades and created to increase aid transparency (this website is now back online).

Other federal dashboards and indices were also offline, at least temporarily, including but not limited to: Area Health Resource Files (a resource of data on health professionals, hospitals, and economic indicators), CDC’s Social Vulnerability Index (Census-based socioeconomic data used for disaster planning, response and recovery), and the Environmental Justice Index (Census tract-level data used to identify populations facing negative environmental, social and health factors).

While not the focus of this brief, other health information intended for the public has also been removed or changed, which could have implications for access to and receipt of services and other interventions.

Between 2019 and 2022, the U.S. experienced a sharper decline and a slower rebound in life expectancy than peer countries, on average, due to increased mortality and premature death rates in the U.S. from the COVID-19 pandemic. Updated life expectancy estimates in this chart collection show that in 2023, life expectancy in the U.S. returned to pre-pandemic levels, but remains lower than that of comparable countries.

This chart collection examines how life expectancy in the U.S. compares to that of other similarly large and wealthy countries in the Organisation for Economic Co-operation and Development (OECD). The countries included in the comparison are Australia, Austria, Belgium, Canada, France, Germany, Japan, Netherlands, Sweden, Switzerland, and the United Kingdom.

The analysis is available through the Peterson-KFF Health System Tracker, an information hub dedicated to monitoring and assessing the performance of the U.S. health system.

With President Trump now in office, his cabinet nominees continue to testify at congressional hearings as part of the nomination process. Robert F. Kennedy Jr. is the nominee to be the secretary of the Department of Health and Human Services (HHS), and his nomination hearings will spotlight a range of HHS activities but may not touch on the full scope of the department’s responsibilities. To better understand HHS’s impact on the health care system and the American people’s coverage, public health, safety, and well-being, what follows is an overview of the activities of the department.

Overview of HHS

The Department of Health, Education, and Welfare was established in 1953 and evolved into the Department of Health and Human Services in 1980 after the Department of Education was established as an independent entity. A relatively new department of the 15 current executive branch departments, HHS has a Fiscal Year (FY) 2024 budget funding estimated at $1.7 trillion, and the department’s budget is about a quarter of the total FY 2024 U.S. federal budget. It has the largest budget of any federal agency and is the largest grant-making agency.

Most federal executive branch health policy is implemented and managed within HHS, though the White House typically plays a major role in policymaking. The department has 13 operating divisions, most of which have a health focus in areas of coverage, research, regulation, resource delivery, and training. Others are focused on social assistance and support for families and communities in need. More than 80,000 HHS employees are located across the U.S. and the world and half of the workforce is outside the greater Washington, D.C. area.

The Public Health Service (PHS) predates HHS and now exists across ten of the 13 operating divisions within the department:

• The Administration for Strategic Preparedness and Response (ASPR)
• The Advanced Research Projects Agency for Health (ARPA-H)
• The Agency for Healthcare Research and Quality (AHRQ)
• The Agency for Toxic Substances and Disease Registry (ATSDR)
• The Centers for Disease Control and Prevention (CDC)
• The Food and Drug Administration (FDA)
• The Health Resources and Services Administration (HRSA)
• The Indian Health Service (IHS)
• The National Institutes of Health (NIH)
• The Substance Abuse and Mental Health Services Administration (SAMHSA)

Led by the Assistant Secretary of Health and the U.S. Surgeon General, the more than 6,000 United States Public Health Service Corps work across HHS and several other federal departments in everyday roles involving their health expertise, but they are also the country’s frontline workers for emergency response including public health emergencies.

Health Care Coverage and Affordability

The largest division of HHS is the Centers for Medicare and Medicaid Services (CMS), responsible for administering or overseeing health insurance coverage for Medicare, Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act’s Health Insurance Marketplaces. Together, these programs provide health coverage access to 170 million Americans—more than half the population. However, the impact of HHS on the nation’s health insurance system goes well beyond the programs it administers, as it is heavily involved in the federal regulation of private health insurance, including employer-sponsored health insurance covering more than 150 million people, in conjunction with the Departments of Labor and the Treasury.

Beyond the core health insurance programs CMS administers, HHS also supports access to health care services in several other ways. Community health centers provide primary care and some additional services to low-income and uninsured populations and often serve special populations, e.g., people experiencing homelessness, migratory agricultural workers, and rural residents. HHS has a central role in setting standards and providing significant funding through various sources. HHS also provides medical and public health care to American Indians and Alaskan Natives through a network of providers run or contracted by the Indian Health Service. It has programs addressing the needs of specific populations, including the Ryan White HIV/AIDS program, refugee health, mental health and substance use treatment programs, and maternal and child health, to name a few.

Public Health and Disease Control

The public health role of HHS has been in the spotlight due to the COVID-19 pandemic, but its role during the crisis was based on pre-existing infrastructure and routine activities that adapt to the needs of the day. The department has a long-standing role in monitoring, preventing, and reducing the spread of infectious and non-communicable diseases. Its role encompasses a wide range of responsibilities, including research, screening, policy development and guidance, public education, treatment, and funding for state and local health departments.

Aside from COVID-19, HHS has been active in addressing infectious disease outbreaks of H5N1 avian flu, mpox, and hepatitis A in the past five years and works on long-term challenges like the HIV/AIDS epidemic. The role of HHS in vaccination dates back to the 1950s polio vaccine and it continues to have a substantial role in influencing the country’s vaccine policy.

Emergency Preparedness and Response

The routine health activities of HHS often merge with its role in addressing the health impacts of public emergencies and disasters. Events like the September 11, 2001, terrorist attacks, the opioid epidemic, the Flint, Michigan water crisis, natural disasters of hurricanes, tornadoes, and wildfires, and disease outbreaks have all triggered an HHS response in conjunction with other federal agencies.

HHS has provided emergency coordination and strategic planning to set up shelters for acute medical care and mental health support, sometimes utilizing the National Disaster Medical System, accessed stockpiles of critical equipment and medicine, led investigations and expanded on testing and monitoring activities, and assisted with survivor and community recovery including continuity of health care services.

Food and Drug Safety

Arguably, the broadest touch point for HHS’ impact on Americans’ daily lives is its role in food safety. The Food and Drug Administration (FDA) oversees most food safety aside from meat and poultry and shares responsibility for egg products with the Department of Agriculture. It also regulates the information about dietary supplements provided to consumers, though it does not have authority to approve them for safety and effectiveness. Among the activities related to food safety are conducting inspections of facilities, labeling requirements, issuing food recalls and alerts, and ensuring imported food meets U.S. standards. However, the FDA isn’t the only HHS agency that plays a significant role in food safety, as the Centers for Disease Control’s broad role of monitoring and responding to disease outbreaks also includes those related to consuming contaminated food.

HHS has a major role in regulating medical drugs and devices, mainly through the FDA. This includes pre-market testing for the safety and effectiveness of a product’s intended use, monitoring of approved products for any harm to consumers, and regulations for producing and labeling such products.

Scientific Research and Innovation

HHS, primarily through the National Institutes of Health, is the world’s largest public funder of health research. While the research often conducted can center on the basics of science and biomedicine, it has led to breakthroughs like the first successful polio vaccine, treatments for cancer and HIV/AIDs, the development of MRI technology, and the ability to personalize medicine because of the mapping of the human genome.

Supporting Families and Communities

The health of individuals can be impacted by several non-medical factors often categorized as social determinants of health. HHS has a range of social service programs that may not be typically considered health services, but usually factor in the stability of individual and family lives.

Financial assistance for low-income families with children has long been a federal program, and Temporary Assistance for Needy Families (TANF) is the primary cash assistance program for this population. TANF is administered by the HHS Administration of Children and Families (ACF) which also has programs related to child support enforcement, foster care, adoption, and child care. It also promotes early childhood development in low-income children under the age of five through Head Start.

One element of the department’s support services that has gained significant attention over the past decade, particularly as refugee resettlement submissions to the U.S. have sharply increased, is the array of services offered by the Office of Refugee Resettlement (ORR). Established 45 years ago, ORR aims to integrate individuals, including unaccompanied minors, and families into American society and provide a pathway to self-sufficiency. Services offered include financial assistance, housing, medical care, and employment services.

When a new Commander in Chief takes office – and their party also controls both chambers of Congress – how quickly can they make changes to health policy? Is it realistic to think that policy changes can happen on “Day One” of a new administration?

The short answer is that administrations can set changes in motion starting on Day One. But government processes and regulations – including federal rulemaking protocols, court actions, and the legislative process – slow the process of implementing changes and may delay them for months or even years.

If you’re among the more than 24 million people who enrolled in 2025 Marketplace coverage during open enrollment, ^{nothing will change about your coverage or premiums this year, since benefit and premium changes happen at the start of a plan year – January 1 for individual market coverage (barring unforeseen circumstances such as the mid-year carrier exit we saw in a few states in 2023).}

Members of the newly sworn-in Congress have circulated a “menu of potential spending reductions for members to consider,” which includes Medicaid per-capita caps and work requirements, repealing the ACA’s Prevention and Public Health Fund, funding cost-sharing reductions (as noted above, de-funding CSR has resulted in higher government spending on premium subsidies), and repealing “major Biden health care rules.”

But significant healthcare legislation would tend to have an effective date months or even years in the future, to give insurers, patients, and medical providers time to adapt. For example, consider the American Health Care Act (AHCA), a partial ACA repeal bill that passed the House in 2017 but failed in the Senate.

The AHCA would have ended the enhanced federal funding that states get for Medicaid expansion under the ACA, but not until 2020. ^{And it would also have replaced the ACA’s income-based Marketplace premium tax credits with age-based fixed dollar tax credits, but not until 2020.}

In summary, a new administration and Congress can make numerous changes to health policy. But while the process can begin immediately, the implementation of changes will generally be delayed by months or even years, depending on the policy.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.

With the incoming Trump administration and Republican-led Congress looking to ways to reduce federal spending, a new KFF Health Tracking Poll finds that the Medicare and Medicaid programs remain broadly popular, and more people favor more spending on those programs than less spending.

About eight in 10 Americans overall view Medicare (82%) and Medicaid (77%) favorably. This includes majorities across partisans, including most Republicans (75% view Medicare favorably and 63% view Medicaid favorably).

About half (46%) of the public say the federal government doesn’t spend enough on Medicaid, more than twice the share (19%) who say the government spends “too much.” The gap is even larger for Medicare, with half (51%) of the public saying the government doesn’t spend enough compared to 15% who say the government spends too much.

The Affordable Care Act (ACA), sometimes called Obamacare, also remains popular, with nearly two thirds (64%) of the public holding favorable views, though with more of a partisan divide. Most Democrats and independents hold favorable views of the ACA, while about three quarters of Republicans (72%) hold unfavorable views.

Large majorities also say they are “very” or “somewhat” worried that people covered by each of the three programs in the future won’t get the same benefits available today. This includes 81% who say so about Medicare, 72% who say so about Medicaid, and 70% who say so about the ACA marketplaces. Republicans are less worried than other partisans about Medicaid and the ACA.

Ahead of President Trump’s inauguration, the poll also assesses how the public prioritizes 11 potential actions on health that the new administration and Congress could take.

About six in 10 say that boosting price transparency rules (61%) and limiting chemicals in the food supply (58%) are both a “top priority.” This includes majorities of Republicans, independents and Democrats.

During his first administration, President Trump issued federal regulations establishing price transparency requirements for hospitals and insurers, and Robert F. Kennedy Jr., his pick to head the U.S. Department of Health and Human Services, has long advocated against chemicals in food.

In contrast, few among the public rank several other health policies associated with President Trump and his allies as top priorities.

For example, about one in seven say that reducing federal spending on Medicaid (13%) or limiting access to abortion (14%) is a top priority, while much larger shares say each of these “should not be done” (44% and 51%, respectively). Other low-ranking priorities include cutting funding to schools that require students to get vaccinated (15%), encouraging communities not to add fluoride to their water supply (23%), and repealing and replacing the ACA (27%).

Among other health priorities:

• Medicare drug price negotiations. More than half (55%) of the public say it is a top priority to expand the number of prescription drugs subject to Medicare drug price negotiations, including most Democrats (65%) and about half of Republicans (48%). Only 3% say this shouldn’t be done.
• Regulating insurance claim denials. Most people (55%) say more closely regulating insurers’ decisions to approve or deny claims for health services or prescription drugs should be a top priority. This includes most Democrats (61%) and independents (59%), along with nearly half (45%) of Republicans. Overall, just 5% oppose this.
• Enhanced ACA subsidies. About a third (32%) say that extending the expanded financial assistance that helps make ACA marketplace health insurance affordable should be a top priority. This includes half of Democrats (50%) but few Republicans (16%). Only 7% say this shouldn’t be done.

The incoming Trump administration has established a new “Department of Government Efficiency,” or DOGE, charged with developing plans to cut federal spending and reduce regulations.

Most Americans (73%) say that reducing fraud and waste in government health programs would lead to “major” or “minor” reductions in federal spending overall. This includes most Republicans (80%), independents (72%), and Democrats (68%).

At the same time, more than half (55%) of the public also say that reducing fraud and waste would lead to reductions in the benefits that people receive from government health programs. At least half of Republicans (60%), Democrats (55%), and independents (51%) hold this view.

Other findings include:

• Most of the public say the government is not spending enough on the prevention of chronic diseases (60%) or prevention of infectious diseases and preparing for future pandemics (54%). Much smaller shares say the government spends “too much” on each of these.
• More than half (57%) of the public say they expect health care to become less affordable for their families over the next few years. This includes most (54%) Trump voters and half (51%) of Republicans despite the campaign’s emphasis on addressing rising costs, including in health care.

Designed and analyzed by public opinion researchers at KFF. The survey was conducted Jan. 7-14, 2025, online and by telephone among a nationally representative sample of 1,310 U.S. adults in English and in Spanish. The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on other subgroups, the margin of sampling error may be higher.

Key Findings

• Both Medicare and Medicaid continue to be viewed favorably by large majorities of the public, including majorities of Republicans, Democrats, and independents. While lawmakers are discussing changes to Medicaid and Medicare including possible spending cuts, about half of the public think the federal government isn’t spending enough on each of these programs. Half (51%) say the federal government spends “not enough” on Medicare, and nearly half (46%) say the same about the Medicaid program. Across both programs, the share of the public who say the government isn’t spending enough is more than twice the share who say the government is spending “too much.”
• The latest KFF Health Tracking Poll also shows bipartisan consensus for some health policy priorities for the new presidential administration and Congress, especially around oversight and regulation. Majorities of the public – including about half or more across partisans – say boosting health care price transparency rules (61%), setting stricter limits on chemicals found in food supply (58%), and more closely regulating the process used by health insurance companies when they approve or deny services or prescription drugs (55%) should be a “top priority” for the incoming administration and Congress. Expanding the number of prescription drugs that the federal government negotiates the Medicare price on is also ranked as a “top priority” by a majority of the public including two-thirds of Democrats, 54% of independents, 48% of Republicans and three-fourths of people who are currently enrolled in Medicare.
• While the public is largely in-line with some of the administration’s potential health care priorities, other possible policy actions are seen as lower priorities, and in some cases, larger shares of the public say they “should not be done.” The public is divided on whether the administration should prioritize recommending against fluoride in local water supplies, with the same share saying it should be a “top priority” (23%) as say it “should not be done” (23%). In addition, less than one in eight adults (including fewer than a quarter of Republicans) say reducing federal funding to schools that require vaccinations (15%), limiting abortion access (14%), or reducing federal spending on Medicaid (13%) should be a “top priority,” while at least four in ten say each of these “should not be done.”
• Nearly two-thirds of adults (64%) hold a favorable view of the 2010 Affordable Care Act (ACA), but views on the future of the law are still largely partisan. Four in ten Republicans (40%) say repealing the legislation should be a top priority, while half of Democrats (50%) say extending the enhanced subsidies for people who buy their own coverage should be a top priority. Overall, most of the public is worried about the level of benefits for people who buy their own coverage through the ACA marketplaces including nearly nine in ten Democrats (86%), nearly eight in ten independents (78%), and nearly half of Republicans (47%).
• Overall, about three-fourths (73%) of the public thinks that reducing fraud and waste in government health programs could lead to reductions in overall federal spending – which is the goal of Trump’s newly formed government efficiency program, but many also think it will result in a reduction of benefits. More than half of the public say reducing fraud and waste could lead to reductions in the benefits people receive from the Medicaid and Medicare programs.

Public’s Health Care Priorities

As President-elect Trump takes office on January 20^th with Republican majorities in both chambers of Congress, the public is sending mixed messages on how they prioritize key components of the Trump administration’s health agenda. While Americans across partisanship largely embrace prioritizing increased regulation and oversight such as boosting price transparency rules and setting stricter limits on chemicals in the food supply, there are other aspects of the Republican agenda the public does not support – most notably, reducing federal funding to Medicaid.

When asked about a variety of health care proposals, including those put forth by Republican and Democratic lawmakers, about six in ten say boosting price transparency rules to ensure health care prices are available to patients (61%) should be a “top priority,” and a similar share say the same about setting stricter limits on chemicals found in the food supply (58%). A majority (55%) also say more closely regulating the process used by health insurance companies when they approve or deny services or prescription drugs is a top priority. Overall, while health care ranks lower than other policy areas such as immigration, foreign policy, and the economy; majorities of the public – including half or more across partisanship – say each of these should be a “top priority” for Congress and the new Trump administration.

When it comes to proposed changes to two key health care legislations: the Inflation Reduction Act’s provisions to allow the federal government to negotiate the Medicare price of prescription drugs as well as the 2010 Affordable Care Act (ACA), larger shares of the public support actions to expand or strengthen these laws rather than repealing them. More than half of the public (55%) say expanding the number of prescription drugs subject to Medicare price negotiation should be a top priority, twice the share who prioritize rolling back this provision (28%). On the ACA, about a third (32%) prioritize extending the enhanced subsidies for people who buy their own health coverage while a quarter of the public (27%) say repealing and replacing the ACA is a top priority.

Other health care issues, many of which may be the focus of the Trump administration, are seen as even lower priorities for the incoming administration with substantial shares of the public saying they “should not be done.” Less than a quarter of the public think changing recommendations for fluoride in local water supplies (23%) should be a “top priority,” which is identical to the share who say it should not be done. Less than one in eight say reducing federal funding to schools that require vaccinations (15%), limiting abortion access (14%), and reducing federal funding on Medicaid (13%) should be top priorities. At least four in ten of the public say each of these “should not be done” by Congress or the Trump administration.

Some Bipartisan Agreement on Health Care Priorities, but Views on ACA Are Highly Partisan

Robert F. Kennedy Jr., President Trump’s choice for head of the Department of Health and Human Services has long touted the need for a complete overhaul of U.S. food policy including cracking down on ultra-processed foods and food dyes. This focus on limiting chemicals in the public’s food supply is echoed in the public’s list of top health care priorities, with majorities across partisans saying it should be a top priority for the new Trump administration and Congress. More than half of Republicans (61%), independents (56%), and Democrats (55%) say setting stricter limits on chemicals in the food supply should be a “top priority” for Congress or the Trump administration.

Majorities of Democrats and independents also say oversight – both boosting price transparency rules to ensure health care prices are available to patients and more closely regulating health insurance companies’ approval or denial of care – should be a top priority for lawmakers. This increased oversight on hospital pricing and insurance companies is also seen as a priority among large shares Republicans (56% and 45%, respectively). Partisans also hold similar views on whether expanding the number of drugs subject to Medicare price negotiation should be a priority, with about half of Republicans (48%) saying this should be a “top priority,” as do nearly two-thirds of Democrats (65%).

There is also bipartisan agreement on what shouldn’t be a top health care priority for lawmakers. Few Democrats, independents, or Republicans think the incoming administration should prioritize changing recommendations for fluoride in local water supplies, reducing federal funding to schools that require vaccinations, limiting abortion access, or reducing federal funding for Medicaid.

On the other hand, views on the future of the 2010 Affordable Care Act continue to be partisan. Repealing the ACA continues to rank as a priority for Republicans (40% say it is a “top priority” in the most recent tracking poll), but it has dropped as priority among the total public (down 10 percentage points), and among Republicans specifically (down 23 percentage points), since the start of the first Trump administration. Democrats, on the other side of the political aisle, are more likely to prioritize extending the Biden-era enhanced ACA marketplace subsidies. Half of Democrats say this should be a “top priority” compared to just about one in six Republicans.

Many Americans Expect Their Health Costs To Continue Increasing

Throughout the 2024 presidential campaign, voters consistently said they were most interested in electing a candidate who could reduce their health care costs. President Trump largely capitalized on voters’ economic concerns and his own record to convince voters that he was the candidate most adept at taking on the high cost of health care. Yet, few Americans now expect health care costs for them and their family members to become more affordable over the next few years. In fact, more than half (57%) of the public – including 54% of Trump voters – say they expect the cost of health care to become “less affordable.” Majorities of Democrats (60%), independents (59%), as well as half of Republicans (51%) all expect health care costs for them and their family members to become less affordable in the coming years.

Public Largely Holds Favorable Views of Government Health Programs

With the Trump administration’s focus on tax cuts and border security, House Republicans have been coming up with plans to pay for these which may include reducing spending on government health programs such as Medicare, Medicaid, and the Affordable Care Act. Yet, changes to these programs may run up against public sentiment according to the latest KFF Tracking Poll.

KFF has asked the public about their attitudes about both Medicaid and Medicare for more than two decades, and these two programs continue to be overwhelmingly popular among the public. In the most recent poll, about eight in ten (82%) Americans hold favorable views of Medicare and more than three-fourths (77%) hold favorable views of Medicaid.

Medicare, the federal government health insurance program for adults 65 and older and some younger adults with disabilities, has maintained favorability among eight in ten adults for nearly a decade. In the January KFF Health Tracking Poll, the share who say they view the program favorably includes three-fourths of Republicans (75%) and more than eight in ten independents (84%), and Democrats (90%). This also includes 94% of the individuals who are currently enrolled in the Medicare program.

Similarly, Medicaid, the federal-state government health insurance program for certain low-income individuals and long-term care program, is also very popular with three-fourths of adults (77%) holding favorable views, including six in ten Republicans (63%), and at least eight in ten independents (81%) and Democrats (87%). Medicaid is also popular among those enrolled in the program with 84% saying they view the program favorably.

Notably, both programs are also viewed favorably by a majority of voters who say they voted for President Trump in the 2024 election.

While lawmakers are discussing changes to these programs including significant cuts to Medicaid, about half of the public actually think the federal government isn’t spending enough on either of these programs. About half of the public (51%) say the federal government spends “not enough” on Medicare, while one-third say the government spends “about the right amount” and about one in seven (15%) say the government spends “too much.” A majority of Democrats (60%) and pluralities of independents (49%) and Republicans (43%) say the federal government doesn’t spend enough on Medicare.

Nearly half (46%) say the federal government doesn’t spend enough on the Medicaid program, with another third saying it spends “about the right amount” and around one in five (19%) saying it spends “too much.” While most Democrats (62%) say the federal government doesn’t spend enough, Republicans are a bit more divided with about similar shares of Republicans saying the government spends “too much” (34%), “not enough” (32%), or “about the right amount” (33%) on Medicaid.

The Affordable Care Act, the Obama-administration health insurance program that was a frequent target of the first Trump administration, also continues to be popular – although to a somewhat lesser degree than Medicaid or Medicare. Nearly two-thirds of the public (64%) view the 2010 ACA favorably while less than four in ten (36%) say they hold an unfavorable view of the law. The share of the public who views the law unfavorably continues to be largely made up of Republicans, with about three-fourths (72%) saying they have an unfavorable view. ACA favorability increased substantially during the 2017 repeal efforts, and has maintained majority support throughout the past four years of the Biden administration.

With possible changes to all three government health programs, the public is worried that people covered by each of these programs in the future will not be able to get the same level of benefits that are available today. About eight in ten (81%) say they are either “very worried” or “somewhat worried” that Medicare enrollees will not get the same level of benefits in the future. This includes more than eight in ten (82%) individuals who are currently covered by the program as well as about nine in ten adults (88%) who will be eligible for the program in the coming years, those between the ages of 50 and 64.

In addition, seven in ten are worried about the level of benefits that will be available to people covered by Medicaid (72%) and people who buy their own coverage through the ACA marketplaces (70%). Both Medicaid and the ACA have repeatedly been discussed as possible focuses of the incoming Trump administration and Congressional Republicans.

Many Think Federal Government Isn’t Spending Enough on Public Health

As the Trump administration is balancing spending priorities, the public thinks the government isn’t spending enough on many facets of public health, including both the priorities of RFK Jr, Trump’s pick to lead HHS, and the priorities of Congressional Republicans.

Most of the public says the government is spending “not enough” on the prevention of chronic diseases (60%) or prevention of infectious diseases and preparing for future pandemics (54%). More than four in ten said the government was spending “not enough” (45%) on biomedical research, while 38% said it was spending “about the right amount.” Smaller shares say the federal government is spending “too much” on each of the key health priorities asked about.

Public Thinks Government Efficiency Could Decrease Federal Spending, but Worries Efforts May Reduce Benefits

One of the Trump administration’s promises has been to cut excessive government spending, including reducing fraud and waste across various sectors of the government. As the newly-formed “Department of Government Efficiency” or DOGE begins work, the public is concerned about the impact that government efficiency efforts will have on people who get their health insurance through Medicare or Medicaid.

Overall, the public thinks that reducing fraud and waste in government health programs could lead to reductions in overall federal spending – which is the goal of the government efficiency program, but many also think it will result in a reduction of benefits. Four in ten say reducing fraud and waste in government health programs could lead to “major reductions” in federal spending with an additional third (32%) saying it could lead to “minor reductions.” This includes majorities across partisans (80% of Republicans, 68% of Democrats, and 72% of independents) who say reducing fraud and wasted could reduce overall federal spending.

Yet, more than half (55%) of the public also say reducing fraud and waste could lead to reductions in the benefits people receive from the programs. More than a quarter (28%) of the public say that reducing fraud and waste will lead to “major reductions,” with an additional quarter who say it will lead to “minor reductions” in benefits. Once again, more than half across partisans (60% of Republicans, 55% of Democrats, and 51% of independents) say that reducing fraud and waste will lead to reduced benefits.

The public is largely divided on whether the incoming Trump administration’s proposed efforts to improve government efficiency will have a negative or positive impact on people who get health coverage through Medicare or Medicaid. Similar shares say the impact will be “mostly negative” (43%) and “mostly positive” (41%), while 15% say there won’t be any impact. Views of the impact are highly partisan, with large majorities of Democrats (78%) saying there will be a mostly negative impact, and most Republicans (80%) say there will be a mostly positive impact. Independents are more divided, but a larger share say there will be a mostly negative impact (43%).