Thirty-six percent of Americans who have health coverage through the Affordable Care Act's (ACA) marketplaces and 27 percent of people with Medicaid are pessimistic they will be able to keep their coverage in the future, according to a new Commonwealth Fund survey. Nearly half cite actions by the Trump administration or Congress to undermine the law as the main source of their concern. In a companion To the Point post, Sara R. Collins, Munira Z. Gunja, Michelle M. Doty, and Herman Bhupal highlight federal and state policy options that would increase coverage, improve affordability, and ease consumer concerns.