Healthcare affordability

This data brief for Congress reviews data on health care coverage, costs, and federal spending in the context of recent Medicaid reforms and the expiration of enhanced ACA subsidies.
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Access to health insurance and the cost of healthcare were at the center of two major policy debates in 2025: the One Big Beautiful Bill Act (OBBBA) and the government shutdown tied to the debate over enhanced Affordable Care Act (ACA) subsidies. The OBBBA provisions related to Medicaid, and the expiration of the enhanced ACA subsidies, have projections for federal health spending trending lower over the next decade. At the same time, some Medicaid and ACA enrollees may experience barriers to care due to new Medicaid rules and the expiration of the temporarily enhanced subsidies for marketplace insurance coverage.


This brief highlights the data points to watch as these policies roll out, including overall personal healthcare spending, costs to individuals, and federal health insurance program costs and enrollment.

Data summary


  • Several entities pay for healthcare in the US. Considering all payers, the average per-person spending was $13,265 in 2024, nearly 10 times higher than in 1960, after adjusting for inflation.
  • Out-of-pocket healthcare expenditures were $1,637 per capita in 2024, not including the cost of insurance premiums. This was up 118% from 1960, after adjusting for inflation. People 65 and older and those with non-group private insurance (e.g., plans bought from the ACA marketplace) reported the highest out-of-pocket expenses.
  • The uninsured rate was 8% in 2024, down from 14% in 2013, before the major ACA provisions took effect. The share of the population enrolled in private health insurance, Medicare, and Medicaid was higher in 2024 than in 2013 for each type of program. Enrollment increases in federally funded health programs have led to higher federal spending.
  • Around 26 million people could have the Medicaid work requirements that were introduced under the OBBBA.
  • The average cost of insurance premiums (after subsidies) on Healthcare.gov rose from $85 per month in 2025 to $137 in 2026, which was when enhanced ACA subsidies expired. Before the enhanced subsidies, average Healthcare.gov premiums in 2020 were similar to those in 2026 at $145 per month.
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