Eleven insurers exit ACA marketplaces, affecting 1.2 million in seven states

Eleven health insurers have announced they will pull out of certain state marketplaces under the Affordable Care Act in 2027, leaving thousands of consumers facing a sudden loss of coverage options. The exits will affect marketplaces in at least seven states, including Texas, Florida, Ohio and North Carolina, where the departing carriers together cover roughly 1.2 million enrollees. The insurers say they cannot sustain the financial strain of the current market environment and will cease offering plans at the start of the next enrollment cycle.

The move comes after years of mounting pressure on ACA exchanges. Premium subsidies were cut in 2022, and the federal government’s decision to phase out the cost‑sharing reduction payments left many insurers with higher out‑of‑pocket costs for low‑income shoppers. At the same time, risk‑adjustment formulas have not kept pace with the growing share of high‑cost patients, pushing insurers into losses. Several carriers have already left markets in 2021 and 2022, prompting a wave of premium hikes and reduced competition that spurred the latest wave of exits.

State officials and consumer groups warned that the departures could drive premiums up sharply and force remaining insurers to limit plan choices. In Texas, the Department of Insurance said the state will work with the federal marketplace to recruit new carriers, but warned that the process could take months. Ohio’s health commissioner called the trend “a warning sign that the marketplace is no longer viable for many providers.” The insurers cited in the announcement include UnitedHealthcare, Anthem, Cigna and several regional carriers, all of which said they will continue to offer plans in other states where they remain financially stable.

The fallout will play out during the 2026 open enrollment period, when consumers must decide whether to stay on existing plans or switch to alternatives. Federal officials have said they will monitor the situation and consider emergency measures, such as temporary reinsurance or additional subsidies, to keep markets open. Lawmakers are also expected to debate legislation that could restore cost‑sharing reductions or adjust risk‑adjustment payments. For consumers, the key will be to watch state communications closely and explore Medicaid expansion or private options if marketplace choices disappear.