The Brief

For millions of Americans who buy their own health insurance through the Affordable Care Act marketplace, the end of the year brings a day of reckoning: It's time to compare benefits and prices, and consider changing to a new plan, or enroll for the first time.

Open enrollment starts Wednesday for the ACA's federal and state exchanges. Consumers can go online, call, or seek help from a broker or other assister to learn their 2024 coverage options, calculate their potential subsidies, or change plans.

In most states, open enrollment lasts through Jan. 15, although some states have different time periods. California's, for example, is longer, open until Jan. 31, but Idaho's runs from Oct. 15 to Dec. 15. In most states enrollment must occur by Dec. 15 to get coverage that begins Jan. 1.

Health policy experts and brokers recommend all ACA policyholders at least look at next year's options, because prices — and the doctors and hospitals in plans' networks — may have changed. Here's what else you need to know.

People bumped from Medicaid may be eligible, and could make it another record year for signups

ACA plans are now well entrenched — an estimated 16.3 million people signed up during open enrollment last year. This year may see even larger numbers. Enhanced subsidies first approved during the height of the COVID pandemic remain available, and some states have boosted financial help in other ways.

In addition, millions of people nationwide are losing Medicaid coverage as states reassess their eligibility for the first time since early in the pandemic. If you're one of those ousted, be aware you could be eligible for an ACA plan. You can sign up as soon as you know you're losing Medicaid coverage — even outside of the open enrollment season.

Assistance from brokers comes with new strings

An important caution: Don't wait until the last minute, especially if you are seeking help from a broker. Consumers this year will be asked to certify that they voluntarily agreed to brokers' assistance and that their income and other information provided by brokers is accurate.

It's a good protection for both parties, said broker Joshua Brooker, founder of PA Health Advocates in Pennsylvania. But brokers are concerned the requirement could cause delays, especially if clients wait until right before the end of open enrollment to apply.

"Brokers will need to stop what they are doing right at the end before they click 'submit' and wait for the consumer to sign a statement saying they reviewed the policy," Brooker said.

Your premiums could go up — shop around

While some health plans are lowering premiums for next year, many are increasing them, often by 2% to 10%, according to a Peterson-KFF Health System Tracker initial review of rate requests. The median increase, based on a weighted average across its plans for each insurer, was 6%.

Premiums, and whether they go up or down, vary widely by region and insurer.

Experts say that's a big reason to log on to the federal website, healthcare.gov, in the 32 states that use it, or on to the insurance marketplace for one of the 18 states and the District of Columbia that run their own. Changing insurers might mean a lower premium.

"It's very localized," said Sabrina Corlette, research professor and co-director of the Center on Health Insurance Reforms at Georgetown University. "People should shop to maximize their premium tax credit, although that might require not only changing to a new insurance plan, but potentially also a new network of providers."

Most people buying their own coverage qualify for the tax credit, which is a subsidy to offset some, or even all, of their monthly premium. Subsidies are based partly on the premium of the second-lowest-priced silver-level plan in a region. When those go up or down, possibly from a new insurer entering the market with low initial rates, it affects the subsidy amount.

Household income is also a factor. Subsidies are on a sliding scale based on income.

Subsidies were enhanced during the pandemic, both to increase the amount enrollees could receive and to allow more families to qualify. Those enhancements were extended through 2025 by President Joe Biden's Inflation Reduction Act, passed last year.

Online calculators, including one at healthcare.gov, can provide subsidy estimates.

You may qualify for lower deductibles and copays

In addition to the premium subsidies, most ACA enrollees qualify for reduced deductibles, copayments, and other types of cost sharing if their income is no more than 2.5 times the federal poverty level, or about $75,000 for a family of four, or about $36,450 for a single-person household.

ACA plans are grouped into colored tiers — bronze, silver, gold, and platinum — based largely on how much cost sharing they require. Bronze plans offer the lowest premiums but usually the highest copayments and deductibles. Platinum plans carry the highest premiums but the lowest out-of-pocket expenses for care.

Cost-sharing reductions are available only in silver-level plans and are more generous for those on the lower end of the income scale. New this year: To help more people qualify, the federal marketplace will automatically switch eligible people to a silver plan for next year if they are currently enrolled in a bronze plan, as long as the enrollee has not made an adjustment in coverage themselves.

There are safeguards built in, said insurance expert and broker Louise Norris, so that people are auto-enrolled in a plan with the same network of medical providers and a similar or lower premium. Additionally, nine of the states that run their own marketplaces — California, Colorado, Connecticut, Maryland, Massachusetts, New Jersey, New Mexico, Vermont, and Washington — have enhanced their cost-sharing reduction programs by extending eligibility or increasing benefits.

Some 26-year-olds will get to stay on parents' plans longer

Happy birthday! Existing federal marketplace rules allowing adult children to stay on their parents' plans though the calendar year in which they turn 26, rather than lose coverage on their 26th birthday, were codified into regulation.

States that run their own markets can set similar rules, and some already allow for longer periods on a parent's plan.

Networks may be small — check that your doctors are covered

Insurance plans often try to reduce premiums by partnering with a limited set of doctors, hospitals, and other providers. Those can change year to year, which is why insurance experts like Norris say enrollees should always check their plans during open enrollment to ensure their preferred physicians and medical centers are included in the network.

It's also a good idea, Norris said, to look closely for changes in prescription drug coverage or copayments.

"The general message is, don't assume anything and make sure you check to see who is in the network," Norris said.

Last year, the Biden administration set rules requiring health plans to have enough in-network providers to meet specific driving time and distance standards. A proposal to limit how long patients wait for a routine appointment has been delayed until 2025.

What we still don't know

A few things remain uncertain as the end of the year approaches. For example, the Biden administration proposed this summer to reverse a Trump-era rule that allowed short-term insurance plans to be sold for coverage periods of up to a year.

Short-term plans are not ACA-compliant, and many have fewer benefits and can set restrictions on coverage, including barring people with health conditions from purchasing them. As a result, they are far less expensive than ACA plans. The Biden proposal would restrict them to coverage periods of four months, but the rule isn't final.

Also pending: a final rule that would allow people to sign up for ACA coverage if they were brought to the U.S. as children by parents lacking permanent legal status — a group known as "Dreamers."

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

The Japanese American National Museum announced today it will reopen in January after a two-year, $25 million overhaul of the country’s largest museum dedicated to the Japanese American experience.

The museum in L.A.’s Little Tokyo is reshaping its galleries and expanding its signature exhibition to include more perspectives and connections between Japanese American history and current debates over race, immigration and democracy.

The new exhibition at JANM features A.I.-assisted avatars of Japanese American survivors of incarceration.

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Courtesy of Japanese American National Museum

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“We want to tell the story in a way that is more expansive and that other immigrants, communities can see their own story reflected,” said Ann Burroughs, the museum’s president and CEO.

That effort to tie history to the present comes as JANM itself has faced political pressure, with the museum losing federal funding amid Trump administration cuts.

From the outside, visitors returning to the museum, which has been closed since January 2024, will recognize its modern, minimalist exterior. Once they step through the doors, though, the experience will be vastly different.

The biggest change will be the installation of a 9,200-square-foot permanent exhibition occupying nearly all of the museum’s first floor — more than twice the space of the exhibition it replaces.

"Common Ground," which opened in 1999, covered Japanese American history from migration to the U.S. in the 1800s to the passage of a federal law — the Civil Liberties Act of 1988 — that formally apologized for the incarceration of Japanese Americans during World War II and provided $20,000 in reparations to surviving detainees.

The new exhibition, called "In the Future We Call Now: Realities of Racism, Forging Democracy," will include more recent history, such as Japanese American support for reparations for Black Americans and vocal opposition to the Islamophobia that swelled after 9/11. It will also cover the Japanese American response to ICE detention and incarceration of migrant children, drawing parallels to World War II camps.

Galleries have been reconfigured to include more recent history and more objects from the past, including kimonos owned by women from Japan, who immigrated to the U.S. in larger numbers starting in the turn of the 20th century.

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Courtesy of Japanese American National Museum

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It will also bring lesser-known perspectives to familiar history through telling the story of incarceration from “women and mothers” and those incarcerated at Tule Lake, the camp in Northern California where Japanese Americans labeled as disloyal by the U.S. government were isolated during World War II.

“JANM hadn’t told that story before,” Burroughs said. “You can’t draw those parallels of what’s happening now if you don’t talk about the camps and if you don’t talk about Tule Lake.”

The new exhibition will also lean more heavily into audiovisual storytelling, using technology and archival media to make the history feel more immediate.

The interactive “StoryFiles” incorporate AI so visitors can pose questions to digital avatars of incarceration survivors like the actor George Takei.

Burroughs stressed that the museum is not using generative AI, but drawing upon hours and hours of interviews in which subjects answered hundreds of questions.

The new exhibition will also draw deeply from JANM’s extensive collection of Japanese American home movies, including footage dating to the 1930s, and give visitors a window into everyday life before World War II.

Some of JANM’s best-known objects will be included in the new exhibition, like barracks from the Heart Mountain incarceration camp in Wyoming and a model of Manzanar in California’s remote Owens Valley, the first of the camps to be built.

The museum is also emphasizing everyday culture, with displays ranging from kimonos brought by Japanese immigrant women at the turn of the 20th century to rice cookers, and the worldwide reach of Hello Kitty.

The Hirasaki National Resource Center has been relocated to the second floor and will showcase work from artists like Ruth Asawa and Isamu Noguchi.

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Courtesy of Japanese American National Museum

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The larger new exhibition was created without growing the museum's footprint through reconfiguring the building. For example, the museum’s Aratani Central Hall will take on a new role as the museum’s main entrance, with visitors entering through its sweeping curved glass wall and moving directly into the exhibition galleries. But Burroughs said the redesign will not come at the expense of the hall’s longtime function as a community space available to local nonprofits.

Upstairs, visitors will find reconfigured spaces including a new reading room filled with works and furnishings by Ruth Asawa and Isamu Noguchi. Behind the scenes, JANM has upgraded decades-old building systems such as its HVAC and elevators.

The museum overhaul was funded as part of a much larger $135 million fundraising campaign, Burroughs said. The rest of the campaign supports JANM’s operations and long-term financial stability, including about $56 million in endowment and board-designated reserves.

"You know, life is never secure in the nonprofit world or in the museum world," Burroughs said. "We have to do a lot more to build up our endowments. We just will keep going."

Public health officials are urging people to be wary of flea-borne typhus after a recent outbreak of the illness.

The outbreak in late July was centered in the Pico-Union neighborhood of Los Angeles. The L.A. County Department of Public Health said five people were hospitalized; all recovered.

The outbreak comes as typhus cases continue to tick up in L.A. County.

Cases have been increasing fairly steadily for more than a decade, but they nearly doubled over the last three years. The Public Health Department logged a record 220 cases in 2025, and officials say this year is on track to exceed that.

Public health officials say the increase is likely because human-animal interactions are also increasing. That could be due to human population expansions into areas with more animals, available food sources for wildlife in populated areas or more people owning pets.

The bacteria that causes typhus is transmitted from animals to humans through fleas.

Typhus can’t be passed from one human to another, and public health experts say the illness is completely treatable, especially if it’s caught early.

Outbreaks and how to prevent them

Most of the time, typhus cases are spread out across L.A. County. But sometimes, there’s a localized spread over a short period of time that turns into an outbreak.

Public health officials respond to a few of them in L.A. County each year.

Generally, outbreaks are triggered by high concentrations of host animals.

“Wherever these animals may be present or wherever they may be congregating, in those areas we can see an increase in the number of human infections,” said Dr. Aiman Halai with the L.A. County Department of Public Health.

The most common hosts for typhus are rats, opossums and free-roaming cats. When people or pets come in contact with host animals, they can pick up the infected fleas and bring them into homes, spreading them to other people and animals in the process.

Halai says a variety of factors can attract animals and lead to an outbreak, including overflowing dumpsters, overgrown vegetation or a well-meaning neighbor feeding local critters.

You can help prevent outbreaks by securing trash in bins, making sure food isn’t left outside, and ensuring pets are on up-to-date flea control medication. Cutting back overgrown vegetation and blocking off crawl spaces can eliminate places where animals can shelter in and around homes.

Halai also says it’s important not to feed wildlife.

Should you be worried?

Although public health experts are wary of the typhus uptick in L.A. County, the 220 cases recorded in 2025 in L.A. County are not overly concerning.

"That’s a very  low rate at the population level,” said Dr. Jeffrey Klausner, a professor of infectious diseases at USC’s Keck School of Medicine.

Typhus is an acute infection caused by bacteria known as Rickettsia typhi. Variations of the bacteria also cause other illnesses transmitted by fleas, ticks, lice and mites, including tick-borne Rocky Mountain Spotted Fever.

Doctors can test for typhus fairly easily, and it is treatable with antibiotics. Symptoms are similar to the flu, and can include fever, headaches, muscle aches and nausea. It can also cause rashes in some cases.

Most infections are mild, but they can cause hospitalization and, in rare cases, can be fatal.

Klausner said the concern is that testing for typhus is not always routine.

“The most important thing is that when patients come in to their doctor — and they have fever, they may have a rash, they may have headache, may have muscle or joint aches — that the doctor's thinking about potentially flea-borne infectious diseases because the treatment can be different,” Klausner said.

The best treatment for typhus is the antibiotic doxycycline. If a patient with typhus gets another type of antibiotic like penicillin or amoxicillin, the treatment may not be as successful.

According to Klausner, when presented with flu-like symptoms, it’s also a good idea for patients to tell their doctors if they’ve been around animals, spent time in an encampment or even just gone on a hike.

Topline:

Why it matters: The small amphibian is found in the grasslands of Southern California and the Central Valley. But habitat loss, urban sprawl and longer droughts have been threatening the species’ population in recent decades.

What the protections do: Now that the Western spadefoot is a candidate for permanent protections, any development project planned for Western spadefoot habitats will have to take the amphibians into account.

Some exceptions may apply: The commission did carve out exceptions for solar projects in the Central Valley. To take advantage of federal tax credit deadlines, some projects can continue to be built, as long as they protect breeding pools and curtail construction during the season when spadefoots are most active.

What conservationists say: Brendan Cummings, conservation director with the Center for Biological Diversity, said in Southern California the biggest threat to the Western spadefoot is not solar development: “It’s warehouses or data centers and road widenings and all manner of construction activities.”

What happens next: The California Department of Fish and Wildlife will conduct a year-long review to determine if the Western spadefoot should be permanently protected.