Total spending since enactment (2014–2024)

 

Total spending since enactment (2014–2024)

• One estimate says exchange subsidies + related programs cost a combined about $694 billion from 2014 through 2024. Paragon Health Institute

This is the federal outlay for subsidizing ACA marketplace plans (not including Medicaid expansion).

Medicaid expansion spending (ACA provision)

• Under the ACA’s Medicaid expansion, the federal government covers a large share of costs for newly eligible enrollees. One analysis estimates Medicaid expansion cost about $873 billion from 2014 to 2024. Paragon Health Institute

Medicaid expansion is part of the ACA but technically a different subsidy program, paid mainly through federal matching payments.

 

 

 

• In 2019, annual ACA marketplace subsidies were roughly $57 billion. By 2024, that is projected to rise to about $125 billion per year. Ways and Means

• Broader federal subsidies for health by 2023 (health sector including ACA tax credits) were about $1.6 trillion total, of which around $91 billion (≈6%) was ACA marketplace subsidies. Peterson Foundation

 

 

Summary — Rough ACA Federal Subsidy Spending Since ACA Began

Time period	ACA exchange subsidies (federal)	Medicaid expansion (federal)
2014–2024	~$694 billion subsidy costs	~$873 billion Medicaid costs