Health Issues

On July 3, the House passed the same version of the budget reconciliation bill that the Senate passed on July 1. On July 4, President Trump signed the bill, previously known as the “One Big Beautiful Bill Act,” into law. This summary describes the health care provisions in four categories: Medicaid, the Affordable Care Act, Medicare and Health Savings Accounts (HSAs). An implementation timeline of the health provisions is available along with more background and a side-by-side comparison of the House and Senate passed bills.

Read the news release about these poll findings.

Key Takeaways

• Following passage of the tax and budget reconciliation bill, dubbed the “big beautiful bill” by President Trump and Republicans, public attention to the bill has increased. Two-thirds now say they’ve heard “a lot” or “some” about the legislation, up from half who said so in June. Overall views remain largely negative, with about two-thirds (63%) continuing to hold unfavorable views of the legislation – which is similar to the share who said the same last month before the legislation passed. Despite this stability in overall views, partisan divides have widened, with the share of Republicans expressing favorable views increasing from 61% to 78% and the share of Democrats expressing unfavorable views rising from 85% to 94%.
• Almost half (46%) of adults think the legislation will hurt them and their family, while a quarter (28%) don’t expect to be affected and another quarter (26%) think it will help them, up from 17% in June. The shift in perceptions of how the law will impact families is largely driven by Republicans and especially those who identify with the MAGA movement. Over half (54%) of Republicans now think the legislation will help them and their family, up from a third (32%) who said so in June. Among Republicans and Republican-leaning independents who identify with the MAGA movement, six in ten (61%) now expect the law to help their families, up from four in ten (38%). A majority of Democrats (72%) and about half of independents (53%) continue to say the law will hurt them and their family.
• Reflecting where most people get their news, a majority of adults, and similar shares across partisans, say they saw information about the tax and budget bill on social media in the past month (78% of those who use social media, and 73% of all adults). About half of those who saw content about the tax and budget bill on social media say the content was mostly in opposition to the bill, while fewer (11%) say the content they saw was mostly in support of it, and about four in ten (41%) saw a mix of both positive and negative content. Reflecting the partisan bent of most social media feeds, Democrats are much more likely to say they saw content in opposition to the legislation, whereas Republicans are much more likely to say they saw content in favor of the legislation or a mix of both positive and negative. Regardless of the tone of the social media content, most of those who saw content about the tax and budget bill on social media say it was a least “somewhat helpful” in helping them understand what the bill does.

Awareness and Impact of the Reconciliation Legislation

Earlier in July, the tax and budget bill, also known by Republicans as the “big beautiful bill,” was passed in Congress and signed by President Trump. The legislation has been lauded by Republicans as the largest tax cut in history for middle- and working-class Americans, but others describe it as the largest rollback in health programs, containing provisions that would significantly cut and drastically change Medicaid and the Affordable Care Act (ACA). The latest KFF tracking poll shows that as public awareness of the legislation has increased, partisan divides in opinion of the law have widened.

Two-thirds (68%) of the public now say they have heard “a lot” or “some” about the tax and budget bill, up from half who said the same in June. Another quarter say they’ve heard “a little” (23%), while few (9%) say they have heard “nothing at all.” Democrats remain somewhat more likely than Republicans and independents to say they’ve heard at least “some” about the legislation. Among Republicans and Republican-leaning independents, those who consider themselves part of the MAGA movement are more likely to have heard “a lot” or “some” about the law compared to non-MAGA Republicans (71% vs. 57%).

Two-thirds (66%) of those who self-purchased their insurance and six in ten adults under age 65 with Medicaid coverage, two of the groups that will be most directly impacted by the law, say they’ve heard “a lot” or “some” about the legislation.

Overall favorability for the “big beautiful bill” remains relatively low, with about one-third (36%) of adults holding a favorable opinion and six in ten (63%) having an unfavorable view.  Overall views of the reconciliation bill remain unchanged from KFF’s June tracking poll, which was conducted prior to the Senate passing the legislation. This overall stability masks a widening partisan divide in views. Favorability among Republicans has increased 17 percentage points since June, from 61% to 78%. At the same time, Democrats have become even more negative in their views, with 94% expressing an unfavorable opinion, up from 85% in June. Favorability among independents has remained steady but still low, with around one-quarter (26%) expressing a favorable view of the legislation, similar to the share in June (27%).

Among Republicans and Republican-leaning independents, those who identify with the MAGA movement express more favorable opinions of the law than those who don’t identify as MAGA (85% vs. 54%). Notably, however, the share of non-MAGA Republicans viewing the bill favorably increased from one-third (33%) in June to a slight majority (54%) after it was passed and signed into law.

Among Medicaid enrollees under age 65 – a group that is most likely to be impacted by the health provisions of the reconciliation law, three in ten (29%) have a favorable opinion, while seven in ten (69%) view the bill unfavorably. Additionally, almost half (46%) of those who purchased their own insurance (46%) have a favorable opinion, while 53% are unfavorable.

Among adults with household incomes of less than $40,000 annually, few (30%) hold favorable views of the law.

Almost half (46%) of adults say they think the tax and budget legislation will generally hurt them and their family, similar to the share who said so in June (44%). About a quarter (26%) of adults think the law will “help,” up from 17% in June. Another quarter (28%) think it won’t make a difference for them and their families.

The uptick in the share who believe the bill will help them and their families is largely driven by Republicans. After passage, just over half (54%) of Republicans think the reconciliation bill will help them and their family, up from a third (32%) who said so in June. At the same time, the share of Republicans who say the bill won’t impact their families decreased from 47% to 33%. Among Republicans and Republican-leaning independents who identify with the MAGA movement, six in ten (61%) now say the bill will help them, up from 38% in June. Non-MAGA Republicans are more divided, with 38% expecting the bill to help their families, with three in ten respectively expecting it to hurt (30%) or saying it won’t make much difference (32%). Seven in ten Democrats (72%) and about half of independents (53%) continue to say the bill will hurt them and their family.

Those with lower incomes are much more likely to say that the tax and budget bill will hurt them and their families, with over half (56%) of those with a household income of less than $40,000 a year who say so.

Two-thirds (65%) of Medicaid enrollees say the tax and budget bill will hurt them and their families, while just under one in ten (18%) believe it will help. Four in ten (38%) of those who have insurance that they purchased themselves expect that the legislation will generally hurt them and their family, while a similar share (35%) say it won’t make much of a difference. Fewer (26%) say it will help them and their family.

The Reconciliation Legislation on Social Media

A majority of adults (78% of those who use social media, and 73% of all adults) and similar shares across partisans say they saw information about the tax and budget bill on social media in the past month – reflecting the type of information the public is getting from their social media feeds. Among those who use social media, the share who say they saw information about the tax and budget bill on social media is similar to the share who say they saw information about other prominent topics on social media, including immigration (85%) and the U.S. economy (83%). Smaller shares of those who use social media report seeing information about Medicaid (58%) or the Affordable Care Act (34%) on social media in the past month.

The share of adults who report seeing information about each topic is similar across age groups but slightly differs across partisanship – perhaps reflecting the partisan bent of social media feeds. While similar shares of partisans say they saw information about the tax and budget bill, immigration, and the U.S. economy, Democrats who use social media were more likely than Republicans to say they saw information about Medicaid (67% vs. 48%) and the Affordable Care Act (39% vs. 24%) on social media in the past month.

Reflecting in part the sites’ widespread adoption among the public, Facebook is the most common reported source of information seen about the tax and budget bill, followed by YouTube. About six in ten (62%) adults who say they saw information about the tax and budget bill on social media say they saw it on Facebook (49% of all social media users), including majorities of Democrats, independents, and Republicans. About four in ten (42%) of those who saw information say it was on YouTube (33% of all social media users), followed by about least one in five adults who use social media saying they saw it on Instagram (24%), TikTok (23%), or on X, formerly known as Twitter (19%). Fewer adults who use social media report seeing information about the tax and budget bill on other social media apps or sites, including Reddit (11%), Truth Social (4%), Bluesky (2%), or Snapchat (2%).

Among those who saw information about the tax and budget bill on social media, about half (47%) say most of the content they saw was in opposition to the tax and budget legislation, while about one in ten (11%) say the content was mostly in support of the legislation, and an additional four in ten (41%) say they saw a mix of both. Reflecting the partisan bent of most social media feeds, about three in four (76%) Democrats who say they saw content say that was in opposition to the bill, while Republicans are more likely (26%) to say the content was in support of the legislation. Notably, about half of Republicans who saw information about the legislation on social media say the content they saw was a mix – perhaps reflecting the debate among Republican lawmakers leading up to the bill’s passing.

Most (62%) people who say they saw content about the tax and budget bill on social media say it was at least “somewhat helpful” in understanding what the bill does, including about one in six (16%) who found it “very helpful.” An additional one in four (27%) say it was “not too helpful,” while a further one in ten (11%) say it was “not at all helpful.” Democrats (72%) and independents (66%) are more likely to say that they found the content helpful in explaining what the bill does compared with Republicans (51%). One in four (25%) young adults under age 30 say the content they saw on social media about the bill was “very helpful” in helping them understand what it does, larger than the shares of older adults who say the same.

The One Big Beautiful Bill Act (OBBBA) – or H.R. 1 ^{– has set the stage for sweeping changes to U.S. health coverage, many of which won’t take effect until 2027 or later. But some changes are happening much sooner – starting right now, later in 2025 and early 2026 – and will significantly impact Medicaid enrollees, Marketplace consumers, and low-income immigrants.}

In this article, we look at five major changes for consumers to watch, some of which take effect immediately.

In 2023 and 2024, the Biden administration finalized a two-part rule designed to simplify and streamline the application and renewal process for Medicaid (including Medicare Savings Programs, which help to pay Medicare premiums and out-of-pocket costs for beneficiaries with low incomes and asset levels), the Children’s Health Insurance Program (CHIP), and Basic Health Programs.

The Biden administration’s rule included provisions such as eliminating in-person eligibility interviews for people with disabilities and those 65 or older, changes to ensure that fewer people would lose coverage due to undeliverable mail, and a ban on lock-out periods for children disenrolled from CHIP for failure to pay premiums.

Starting immediately, H.R.1 prohibits the Department of Health and Human Services (HHS) from implementing, administering, or enforcing that rule, at least through September 2034.

As is the case for other Medicaid cuts in the One Big Beautiful Bill, sources project these changes will lead to a decrease in federal Medicaid spending, due to fewer people being enrolled in the program.

What people affected by the change can do: In order to enroll in and renew coverage, people may find that they need to complete additional paperwork or comply with other new rules. If you’re enrolled in Medicaid (including an MSP) or CHIP, it’s essential to make sure that the state Medicaid agency has your correct contact information, and that you quickly respond to any administrative requests related to your eligibility or coverage renewal.

It’s important to note that longstanding federal rules already prevent federal funding from being used to pay for abortion care, except when the abortion stems from rape, incest, or a danger to the mother’s life. (Thus, non-excepted abortions, dubbed “non-Hyde” abortions, cannot be funded with federal money.) So the change under the OBBBA results in federal Medicaid funding being cut for non-abortion care, such as cancer screenings and contraception.

This resulted in some Planned Parenthood clinics notifying patients that they could no longer accept Medicaid.

But Planned Parenthood immediately filed a lawsuit to block the Medicaid funding cut, and a judge issued a 14-day injunction on July 7, temporarily blocking the Department of Health & Human Services from cutting off Medicaid funding to Planned Parenthood.

The governor of Washington announced that if Planned Parenthood’s lawsuit to permanently block the funding cut is unsuccessful, the state of Washington will cover the $11 million in federal Medicaid funding that Planned Parenthood will lose in Washington. ^{As noted above, federal funding cannot be used for non-Hyde abortions, so that $11 million is for other medical services, such as preventive care.}

And applicants should be prepared to provide proof of their income when they enroll in or renew their coverage for 2026, as that will be required if the applicant attests to an income that doesn’t match the information the Marketplace gets from other sources like the IRS.

What people affected by the change can do: When people enroll in Marketplace coverage for 2026, it will be essential to project income as accurately as possible. The Marketplace will ask for proof of income if the projection you provide doesn’t match what the information the Marketplace gets from data sources like the IRS.

It will also be a good idea to double-check your income projection mid-way through 2026, to see if you’re on track to earn roughly the amount you projected when you enrolled. If not, you can update your income in your Marketplace account, and they’ll adjust your subsidy in real time. This could help to avoid having to repay excess APTC when you file your 2026 tax return, which will be particularly important once there’s no longer a cap on how much excess APTC has to be repaid.

In addition to the revised HDHP definition, H.R.1 also relaxes the rules around HSAs and direct primary care (DPC) arrangements. ^{Starting in January 2026, having a DPC membership (in addition to an HDHP) will no longer disqualify someone from contributing to an HSA. In addition, the DPC membership fee will be considered a qualified medical expense, meaning it can be paid with pre-tax HSA funds.}

In addition, HSA contributions reduce a person’s ACA-specific modified adjusted gross income (MAGI), which can affect whether the person qualifies for Marketplace subsidies. This will be particularly important for people to understand starting with the 2026 plan year, as the “subsidy cliff” will return in 2026 unless Congress acts to extend the subsidy enhancements that are scheduled to sunset at the end of 2025.

So a person who is facing the loss of all subsidies in 2026 might find that by contributing to an HSA, they can bring their MAGI into the subsidy-eligible range. Marketplace enrollees should discuss this issue with a financial planner or accountant before selecting a plan for 2026. If contributing to an HSA makes financial sense for them, it will be important to select an HDHP during the open enrollment period, keeping in mind that Bronze and Catastrophic plans will be considered HDHPs as of 2026.

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

ACA Marketplace insurers are proposing a median premium increase of 15% for 2026, according to a new analysis of preliminary rate filings. Based on the early indications, individual market insurers will introduce the largest hike in premiums since 2018, the last time policy uncertainty contributed to sharp premium growth.

Across the 105 ACA Marketplace insurers in 19 states and DC that have submitted rate filings so far, most are requesting premium increases of 10% to 20% for 2026, and more than a quarter are proposing premium increases of 20% or more.

In addition to the anticipated growth in the cost of health care services, insurers have cited several policy changes that they expect to drive up rates next year, including the following:

• The expiration of the enhanced premium tax credits at the end of this year, which have made coverage more affordable and contributed to record-high enrollment in the ACA Marketplaces, is expected to drive up out-of-pocket premium payments by more than 75% on average and cause many healthier enrollees to drop their coverage.
• The impact of tariffs on some drugs, medical equipment, and supplies. Some insurers estimate that they could increase premiums by an average of 3% more than they otherwise would have.

Other factors could also affect premium changes, including the budget reconciliation legislation and Marketplace Integrity and Affordability rule, both of which were enacted and finalized after many of these insurers submitted their preliminary rate filings. Finalized 2026 rate changes are expected to be published in late summer.
Subsidized enrollees are generally shielded from annual rate increases as their tax credits keep premium payments capped at a portion of their income.

However, with enhanced tax credits set to expire later this year if Congress takes no action to extend them, subsidized enrollees will pay more because they have less financial assistance. Middle income people with incomes above four times the poverty level would no longer be eligible for assistance and would have to shoulder the full premium.

The full analysis and other data on health costs are available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

This analysis of preliminary rate filings submitted by 105 ACA Marketplace insurers in 19 states and DC finds that ACA Marketplace insurers are requesting a median premium increase of 15% for 2026, which would represent the largest hike in premiums since 2018, the last time policy uncertainty contributed to sharp premium growth.

In addition to the anticipated growth in the cost of health care services, insurers have cited several policy changes that they expect to drive up rates next year, including the expiration of the enhanced premium tax credits at the end of this year and the impact of tariffs on some drugs, medical equipment, and supplies.

The full analysis and other data on health costs are available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

On July 4, 2025, President Trump signed the recent reconciliation bill into law which is expected to leave millions of low- and moderate-income people uninsured as they lose access to Medicaid. Additionally, questions remain about whether Congress will preserve enhanced Affordable Care Act (ACA) premium tax credits for those with marketplace coverage, without which millions more could find premiums unaffordable, disenroll, and become uninsured. Given LGBT adults have lower incomes and higher rates of Medicaid coverage than non-LGBT adults, these changes could disproportionately impact this community. Additionally, as LGBT people experience a wide range of health disparities, cost barriers may serve to exacerbate these differences.

This brief reviews new data from the May 2025 KFF Health Tracking Poll on LGBT adult’s experiences and concerns related to health care affordability. Overall, the survey findings show that LGBT adults face more widespread problems and concerns with health care affordability compared to non-LGBT adults. While this may reflect the lower average incomes of LGBT adults, many of these concerns cut across income, with similar shares of LGBT adults reporting concerns regardless of whether they have lower- or more moderate- income.

Findings

U.S. adults face challenges affording a range of common expenses, including those related to health care. Half (51%) of LGBT adults say that in the past year, they or a family member living with them has had problems paying for food, housing, transportation, or other necessities. This compares to three in ten non-LGBT adults. Over one-third (36%) of LGBT adults say they or a family member living with them has had problems paying for health care, compared to one in five (21%) non-LGBT adults. The differences between these groups may be due in part to LGBT adults generally being younger and having lower household incomes than non-LGBT adults. However, even when looking only at those under 35 years old, LGBT adults are still more likely than non-LGBT adults to say they or a household member had problems paying for necessities (62% vs. 38%) and health care (46% vs. 24%).

LGBT adults with household incomes under $40,000 are more likely than LGBT adults with higher incomes to say they or a household member have experienced problems paying for food, housing and other basic necessities in the past year (63% vs. 36%). Issues with health care affordability cut across income levels among LGBT adults, as 40% of lower-income LGBT adults report problems paying for health care in the past 12 months, statistically similar to the share of higher-income LGBT adults who say the same (32%).

Paying for health care can be a burden for individuals and families, including for LGBT adults who tend to have lower incomes. About half (52%) of LGBT adults say it is difficult for them to afford their health care costs, including about one in five (18%) who say it is very difficult. This experience is more common among LGBT adults than non-LGBT adults and is driven by those finding affordability very difficult.

These challenges with affordability can have an impact on access to and willingness to seek care. Half (51%) of LGBT adults report that they have skipped or postponed getting the health care they needed in the past year because of the cost compared to one-third (34%) of non-LGBT adults. About half of LGBT adults with incomes under $40,000 (50%) and about half of those with incomes of $40,000 or more (53%) say they have skipped getting needed health care because of the cost. Additionally, one in four (25%) LGBT adults say their health got worse because they skipped or postponed care because of the cost, compared to 18% of non-LGBT adults who say the same.

Similarly, costs related to prescription drugs also lead some LGBT adults to take actions to reduce their expenses in this area. About one-third (32%) have taken an over-the-counter drug instead of getting a prescription filled, a quarter (26%) have not filled a prescription because of the cost, and almost as many (23%) have cut pills in half or skipped doses. More than four in ten LGBT adults (44%) report taking at least one of these actions, compared to about a third (32%) of non-LGBT adults. Notably, similar shares of LGBT adults with incomes under $40,000 and those with incomes of $40,000 or more report taking at least one of these cost saving actions with their prescription medications (43% and 46% respectively).

Not surprisingly, these experiences translate to worry. Over half of LGBT adults express worry about being able to afford each of the following for themselves and their family: health costs, unexpected medical bills, rent/mortgage, food, gas/transportation, and utilities. Worry about affording health costs and unexpected medical bills are among the expenses of greatest concern to LGBT adults, with about two-thirds reporting they are worried about these expenses (68% and 66%, respectively). LGBT adults are more likely than non-LGBT adults to report affordability concerns related to rent/mortgage, food, and gas/transportation and similarly likely to report such concerns related to health care costs.