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.