HEALTHCARE POLICY | MARKET ANALYSIS
Cigna’s ACA Exit Is the Latest Domino. The Death Spiral Is Already Here.
Alexandra Sczcepaniak | COO, Solidarity Health Network, Inc. | May 2026
Cigna just announced it’s exiting the ACA Marketplace at the end of 2026. 369,000 people will need to find new coverage — or go without. This isn’t an isolated corporate decision. It’s the latest domino in a collapse that has been building in plain sight.
The Exodus Is Already Underway
Aetna left at the end of 2025, forcing roughly a million members to find new coverage. A wave of smaller insurers followed — Molina, HAP CareSource, Mountain Health CO-OP, Primewell, Celtic/WellCare, Baylor Scott & White. Before open enrollment for 2027 even begins, at least half a million more people will be scrambling for comparable coverage at significantly higher prices.
The Mechanism: A Textbook Death Spiral
The driver behind all of it is not a mystery. When Congress let the enhanced premium tax credits expire at the end of 2025, premiums spiked. The healthy people — younger, lower-utilization, the ones doing the math and deciding to gamble on another good year — left first.
The people who stayed are the chronically ill, the older, the ones who have no choice. A smaller, sicker pool means higher claims. Higher claims mean higher premiums. Higher premiums push out more healthy enrollees. And the cycle accelerates.
This is a death spiral. And everyone with a hand in building it is responsible.
Accountability Across the Board
Congress let the tax credits expire knowing exactly what the actuarial math would produce. Carriers optimized for Wall Street on the way in and are exiting before the bill comes due — with no accountability for the people left behind. And advisors and consultants who have been praising individual market conversions without modeling what happens in year five and year ten when healthy people exit and premiums follow — that’s a conversation we need to have too.
What’s Filling the Void
The smaller health plans filling the void don’t have the capital reserves or administrative experience of the carriers leaving. Their long-term viability is unproven. And the American people who have nowhere else to go are being handed shrinking networks, skyrocketing premiums, and a narrowing set of options — while the companies that shaped this market report record revenues and take earnings calls that don’t include a single question about the people losing coverage on January 1st.
A Direct Challenge to Individual Market Advocates
The writing is on the wall. It has been for some time.
So to those who are still praising individual market conversions and the move away from group protections — I genuinely want to hear from you. What are you seeing that the rest of us are missing? Because from where I sit, the evidence is pointing in one direction and it isn’t toward the individual market getting more stable, more affordable, or more accessible for the people who need it most.
This isn’t a political post. It’s a people post. And the people are running out of options.
#ACA #HealthcarePolicy #AffordableCareAct #EmployeeBenefits #HealthInsurance #Cigna #IndividualMarket #GroupBenefits #SHN #HealthcareLeadership
Solidarity Health Network, Inc. | Cleveland, Ohio | shninc.org | Founded 1989