The Obamacare marketplace is reportedly facing significant upheaval following the expiration of enhanced federal subsidies.
Cigna announced in late April that it will leave the Affordable Care Act (ACA) exchanges in 2027, which could further shake up the individual marketplace. CVS’ Aetna ceased offering plans and overall enrollment has declined since Congress refused to renew ACA subsidies, The Hill reported.
“Medical insurance has become unbearably expensive, and this is even before a single service is used,” Jeffrey Tucker, founder and president of the Brownstone Institute, told the Daily Caller News Foundation. “For many people this truly makes no [sense].”
“Crowdsourced alternatives [to the ACA] are doing well even with the legal limits,” Tucker added. “Some people with built up [Health Savings Accounts (HSAs)] who go independent drop medical insurance completely and take their chances. This is actually a rational choice.”
Tucker emphasized that some U.S. insurers are facing “extreme limits” to “leaving the [Obamacare] system now.”
In most cases, carriers who decide to exit the market elect to do so at the end of the calendar year, according to a May 1 report from Healthinsurance.org. Mid-year carrier exits have been highly uncommon in the ACA-compliant individual market.
“There are draconian mandates on business,” he explained, adding that “the exit ramps are too restrictive.” He also said Americans “desperately need universal and unlimited HSAs and we need further to break down the defined benefits mandates.”
An HSA is a type of savings account that allows people to set aside money on a pre-tax basis to pay for qualified medical expenses, according to HealthCare.gov.
A KFF survey published in March found that 80% of returning ACA Marketplace enrollees said their 2026 plan’s premiums, deductibles or coinsurance and co-pays are higher than last year, including 51% of returning enrollees who say they are now “a lot higher.”
Almost 23 million Americans get medical insurance through one of the online exchanges that operate under the ACA, according to Pew Research Center. An estimated 8% of U.S. adults under age 65 who generally worked over 20 hours per week in 2023 got their coverage in the individual market, KFF reported in September 2025.
The Centers for Medicaid and Medicare (CMS) stated in a January fact sheet that the agency is “exercising its full statutory and regulatory authority to protect consumers from unauthorized enrollment activity and safeguard the integrity” of the ACA exchanges.
Neither Cigna nor CMS responded to the DCNF’s request for comment. Aetna declined to comment.
The Congressional Budget Office (CBO) estimated in October 2025 that 2.3 million marketplace enrollees improperly claimed the premium tax credit via intentional overstatement of income for that year.
The Department of Justice announced in February that two executives were each sentenced to 20 years in prison after being found guilty of being involved in a years-long scheme to defraud the ACA program. The Wall Street Journal editorial board asserted in December 2025 that Obamacare has become a “Mecca for fraud.”
“The ACA exchanges are not in upheaval; they are adjusting after a period of subsidy expansion and a tremendous increase in enrollment, much of it improper,” Gabrielle Minarik, program manager at the Paragon Health Institute, told the DCNF.
“Following the law’s early instability, coverage stabilized during the first Trump administration as reforms expanded consumer options and restored greater market discipline,” Minarik explained. “The 2026 debate reflects a return to the ACA’s original subsidy framework after the expiration of temporary COVID-era subsidy boosts. The enhanced subsidies distorted prices, weakened eligibility safeguards, inflated enrollment, led to widespread improper and phantom enrollment, and imposed substantial costs on taxpayers as well as people enrolled without their consent.”
In 2021, federal spending on the ACA exchanges hit $60 billion, leading to 1.6 million additional Americans obtaining private insurance coverage, according to Paragon Health Institute estimates published in October 2023. U.S. taxpayers paid an estimated $36,798 per each additional private insurance enrollee and $20,739 for each additional non-group enrollee, which was notably more than three times as much as the CBO’s original estimates, Paragon Health Institute reported.
“Some enrollment decline is expected, given the large numbers of improper and phantom enrollments,” she continued. “Republicans and the administration have responded with targeted relief options rather than even higher subsidies to insurers, underscoring a preference for sustainable reforms over fiscal dependency.”
Minarik also said she thinks “a wave of additional insurer exits from the ACA marketplace is unlikely.” She added that “further reductions in effectuated enrollment” in the individual marketplace are likely to occur “as the market returns to more normal subsidy parameters and program integrity measures take effect.”
In June 2025, CMS issued a final rule aiming to finalize “additional safeguards to protect consumers from improper enrollments and changes to their health care coverage, as well as establishes standards to ensure the integrity of the ACA Exchanges.”
A recent report from Wakely Consulting Group, a strategic consulting firm, projects that coverage in the marketplaces may plummet by up to 26% in 2026 compared to the average enrollment in 2025. Top Obamacare provider Centene disclosed in March that its enrollment had declined by over 1.5 million over just a few months, Forbes reported.
As of 2025, 93% of ACA Marketplace enrollees received some form of premium tax credit which subsidized their coverage, according to KFF.
In 2025, for enrollees who received advance premium tax credits the average monthly gross premium was $619, per KFF’s estimates. By comparison, the average monthly gross premium for a benchmark silver plan is $625 in 2026, and the average gross monthly premium for an individual’s lowest-cost bronze plan option is $456, KFF reported.
Health insurance premiums for individuals purchasing coverage on their own rose an average of 10% or more annually during the three years before ACA was enacted, according to a June 2014 Commonwealth Fund report.
Democratic Rep. Brittany Pettersen of Colorado claimed Wednesday in a X post that rising healthcare premiums in the U.S. are “added costs for families who are already struggling to cover gas, groceries, and housing.”
Republican Rep. Jason Smith of Missouri wrote in a Jan. 22 social media post that “after 15 years of a Democrat-created health system under Obamacare, [healthcare] prices have only gone up.”
Analysts previously told the DCNF that surging U.S. medical costs will likely play a pivotal part in the outcome of the November’s midterms. Healthcare currently represents almost one in every five dollars spent in the nation’s economy, KFF reported in March.
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