IS THIS THE BEGINNING OF THE END FOR THE ACA?

For the second consecutive year, insurers are seeking double-digit premium increases for ACA marketplace plans.

But rising premiums aren’t the real story.

They’re exposing a problem that has existed since the ACA marketplace began.

Were ACA marketplace plans ever truly affordable if patients struggled to use them?

For more than a decade, we’ve debated whether the ACA expanded insurance coverage. It did. What we haven’t debated enough is whether the model was financially sustainable—or whether it truly expanded access to care.

Today, the warning signs are hard to ignore.

🔹 Premiums continue to rise.

🔹 Taxpayer subsidies continue to grow.

🔹 Healthier people leave the exchanges.

🔹 Insurers are left covering a smaller, sicker population, driving premiums even higher.

That’s not politics.

It’s insurance economics.

As the CEO of an independent physician practice, I’ve seen another consequence firsthand.

The Hirsh Center does not participate in any ACA marketplace plans.

Not because we don’t want to care for those patients.

Because the model makes it extraordinarily difficult to provide the level of care our patients deserve.

🔺 Lower reimbursement.

🔺 Prior authorization that delays treatment.

🔺 Administrative burdens that continue to grow.

🔺 Payment denials that consume hours of physician and staff time.

🔺 Restrictive formularies that limit treatment options.

Every new requirement increases costs without improving care.

Patients think they have health insurance.

Then reality sets in.

🔸 Their physician doesn’t accept the plan.

🔸 The medication they need isn’t covered.

🔸 Their deductible is too high to use their benefits.

🔸 The specialist they need is out of network.

An insurance card is not the same as access to healthcare.

When independent physicians cannot afford to participate, patients lose access.

That may be the ACA marketplace’s greatest flaw.

It measured success by enrollment, not by meaningful access to care.

The current premium increases didn’t create that problem.

They’re exposing it.

Maybe the question was never, “How do we get everyone an insurance card?”

Maybe it should have been, “How do we ensure every American has meaningful access to affordable healthcare?”

Those are not the same question.

If the math no longer works, we should stop asking how to preserve a model that grows more expensive and more dependent on taxpayer subsidies.

We should start asking what comes next.