Cigna announced in late April that it will abandon the Affordable Care Act exchanges in 2027. CVS' Aetna has already stopped offering plans. And a consulting firm projects marketplace enrollment could fall by as much as 26 percent this year. Fifteen years after its passage, the signature healthcare law of the Obama era is shedding insurers, enrollees, and any pretense that massive federal subsidies built something durable.
The proximate cause is straightforward: Congress refused to renew the enhanced premium tax credits that had propped up enrollment since the COVID era. Without that extra taxpayer money flowing to insurers, the economics of the exchanges are reverting to a harsher reality, one that major carriers apparently want no part of.
The numbers tell a grim story for defenders of the law. A KFF survey published in March found that 80 percent of returning ACA Marketplace enrollees said their 2026 premiums, deductibles, or cost-sharing are higher than last year. More than half, 51 percent, said costs are now "a lot higher." The Wakely Consulting Group projects marketplace coverage may plummet by up to 26 percent in 2026 compared to average enrollment in 2025, the Daily Caller News Foundation reported.
Cigna's planned departure in 2027 follows Aetna's decision to stop offering exchange plans altogether. Centene, one of the largest exchange participants, disclosed in March that its enrollment had declined by more than 1.5 million over just a few months.
The pattern is not new. As far back as 2016, Aetna pulled out of 11 of the 15 states where it offered exchange plans, terminating 73 percent of its Obamacare individual policies. Even then, average taxpayer subsidy costs per enrollee had already blown past the Obama administration's original projection of $2,810, reaching $4,308, a 53 percent increase. A Blue Cross Blue Shield Foundation report at the time found that claims in Obamacare individual plans ran 22 percent higher than for people with employer coverage.
Healthinsurance.org noted on May 1 that carriers exiting the market typically do so at the end of the calendar year and that mid-year exits have been highly uncommon. That offers cold comfort to enrollees watching their options narrow.
Almost 23 million Americans get medical insurance through the ACA's online exchanges, according to Pew Research Center. As of 2025, a staggering 93 percent of those enrollees received some form of premium tax credit, per KFF. The average monthly gross premium for a benchmark silver plan in 2026 stands at $625. For the lowest-cost bronze plan, it is $456.
Strip away the subsidies, and what remains is a system that few consumers can afford on their own and that few insurers find profitable enough to stay in. That was the entire design problem from the start, a point that became clear during the law's chaotic rollout, when the federal exchange's computer systems simply failed to work, producing only meager enrollments despite heavy demand. Analysts at the time said the problems ran deeper than website traffic, pointing to software design flaws and insufficient testing.
The cost to taxpayers of keeping this system afloat has been extraordinary. In 2021, federal spending on the ACA exchanges hit $60 billion, according to Paragon Health Institute estimates. That spending yielded just 1.6 million additional Americans with private insurance coverage, meaning taxpayers paid an estimated $36,798 per each additional private insurance enrollee, or $20,739 per each additional non-group enrollee.
Republican Rep. Jason Smith of Missouri put it plainly in a January social media post:
"After 15 years of a Democrat-created health system under Obamacare, [healthcare] prices have only gone up."
Healthcare now represents almost one in every five dollars spent in the nation's economy, KFF reported in March. Before the ACA was enacted, premiums for individuals buying their own coverage were already rising an average of 10 percent or more annually, according to a June 2014 Commonwealth Fund report. The law was supposed to fix that. It didn't.
The subsidy spigot did more than inflate costs. It attracted fraud on a massive scale. The Congressional Budget Office estimated in October 2025 that 2.3 million marketplace enrollees improperly claimed the premium tax credit by intentionally overstating their income 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 involvement in a years-long scheme to defraud the ACA program. The Wall Street Journal editorial board asserted in December 2025 that Obamacare had become a "Mecca for fraud."
CMS responded with enforcement measures. A January fact sheet stated the agency was "exercising its full statutory and regulatory authority to protect consumers from unauthorized enrollment activity and safeguard the integrity" of the ACA exchanges. In June 2025, CMS issued a final rule aimed at finalizing "additional safeguards to protect consumers from improper enrollments and changes to their health care coverage." The tensions within the broader progressive legal and policy apparatus have surfaced in other arenas as well, including a recent rebuke from Justice Kagan directed at a fellow liberal justice over the boundaries of judicial reasoning.
Gabrielle Minarik, a program manager at the Paragon Health Institute, told the Daily Caller News Foundation that the current situation reflects a predictable correction, not a crisis:
"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."
Minarik argued that the enhanced subsidies did real damage to the market's integrity. She said the COVID-era boosts "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."
She noted that coverage had actually stabilized during the first Trump administration, before the enhanced subsidies disrupted the market again. "Following the law's early instability, coverage stabilized during the first Trump administration as reforms expanded consumer options and restored greater market discipline," Minarik said.
On the question of whether more insurers will flee, Minarik said she thinks "a wave of additional insurer exits from the ACA marketplace is unlikely." But she expects "further reductions in effectuated enrollment" as the market returns to pre-subsidy conditions and program integrity measures take hold.
A CMS spokesperson offered a rosier assessment, telling the DCNF that "CMS is committed to a strong, stable, and competitive Marketplace that continues to deliver meaningful coverage options for millions of Americans." The spokesperson acknowledged that "each year, the agency sees issuers expand and contract on the individual market for various reasons" but insisted that "consumers in every state still have access to a range of high-quality plans."
That assurance rings hollow when two of the nation's largest insurers have already left or announced plans to leave. The Obama administration's own administrative "fix" for canceled plans years ago drew confusion and resistance from state regulators and insurers alike, with the National Association of Insurance Commissioners warning at the time that "it is unclear how, as a practical matter, the changes proposed... by the president can be put into effect." The pattern of improvisation and denial has been consistent from the start.
Jeffrey Tucker, founder and president of the Brownstone Institute, told the DCNF that the system has reached a breaking point for ordinary consumers:
"Medical insurance has become unbearably expensive, and this is even before a single service is used."
Tucker said crowdsourced alternatives to the ACA "are doing well even with the legal limits" and that some people with built-up Health Savings Accounts "who go independent drop medical insurance completely and take their chances. This is actually a rational choice." He argued that Americans "desperately need universal and unlimited HSAs and we need further to break down the defined benefits mandates."
But Tucker also acknowledged that "the exit ramps are too restrictive" and that "there are draconian mandates on business" that limit insurers' ability to leave the system. The broader progressive policy infrastructure continues to face pressure on multiple fronts, including the DOJ's recent decision to defend NYU Langone against a potential lawsuit from New York's attorney general over halting a youth program.
Democratic Rep. Brittany Pettersen of Colorado framed the premium increases as "added costs for families who are already struggling to cover gas, groceries, and housing." She is right about the burden on families. She is wrong about who created it.
Minarik noted that "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." That is the fork in the road. One path leads back to ever-larger subsidies that mask the law's structural failures. The other leads toward market discipline, transparency, and consumer choice.
An estimated 8 percent of U.S. adults under 65 who generally worked over 20 hours per week in 2023 relied on the individual market for coverage, KFF reported. These are working Americans, not the indigent, not the elderly, who were promised affordable care and instead got a system that costs more every year, loses insurers every year, and demands more from taxpayers every year.
The Affordable Care Act was sold as a permanent fix. What it delivered was a permanent dependency, on subsidies, on mandates, and on the willingness of taxpayers to keep writing checks for a product that cannot sustain itself. Now that the checks have gotten smaller, the whole structure is listing. That is not a bug in the system. It is the system.