Make Me Smart Are we on the cusp of another big health care debate?
Nov 18, 2025
Julie Rovner, Chief Washington correspondent for KFF Health News and host of the What the Health podcast, shares her insights on the ongoing struggles surrounding the Affordable Care Act. She discusses the potential rollback of COVID-era subsidies and the implications for enrollees. Julie highlights how changes in ACA subsidies could affect employer coverage and budgets, while explaining the risks of a potential ACA death spiral. With impending Medicaid cuts, she emphasizes that these changes may ripple through states and health systems, igniting fresh national health care debates.
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ACA Endures As Central Health Policy Battleground
- The ACA survived many large political fights but remains central to U.S. health policy debates.
- It created major protections and coverage expansions that persist despite repeated attacks.
ACA Reduced The Uninsured Rate Dramatically
- The ACA expanded protections like pre-existing condition coverage and Medicaid in many states.
- These changes drove the uninsured rate from about 17% to about 8% of the population.
Expanded Subsidies Drove Enrollment Surges
- Expanded COVID-era subsidies greatly increased ACA enrollment and affordability.
- Letting those enhancements expire will likely push millions back into uninsurance, per CBO estimates.