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 |
