Rethinking ACA coverage in the wake of rising costs

WASHINGTON, D.C. – Enrollment in the Affordable Care Act marketplace is down while premiums and out-of-pocket costs are up – a combination of factors that creates opportunities for brokers to provide clients with affordable plans that meet their needs.

“Disruption always creates opportunity,” said Michael Papuc, national health sales director at The Brokerage Inc., during Health Agents for America’s 2026 Agent Summit.

He noted that adults aged 18-34 make up 36% of those who dropped ACA coverage, while enrollees are migrating from silver to bronze plans to save money.

“Now the client is in a position where they are feeling the pinch in so many ways,” he said. “What are we doing to get out of the ACA box? When should we consider alternate solutions?”

Many clients don’t know they have options outside of the ACA marketplace because agents often don’t know they have options, said Gaylan Hendricks, managing partner at Integrity Marketing Group who describes herself as Queen of the Bundle.

“It’s about affordability,” she said. “Our job is to keep people out of bankruptcy court and keep them well.”

ACA: One market to rule them all?

In The Lord of the Rings, the One Ring is inscribed with a couplet that begins with “One Ring to rules them all.”

Daniel Cruz, founder of Presidio HealthCare, compared the ACA with the One Ring.

“I think what’s happening here is that the ACA was thought of as the one market to rule them all,” he said. “But it only served people if you subsidized them to an enormous amount. Rolling back subsidies means the ACA will serve one type of person – it will be a safety net for low-income, high-risk individuals. Premiums are high, networks are skinny, and there is rising cost-sharing on the back end.”

The private market can provide options that agents and clients can put together to fill the gap “and prove to clients and Washington that the private market can serve a better product than the federal government can - and that’s our moment in time.”

Hendricks said the ACA “will create such an amazing opportunity.”

“This will be the most phenomenal open enrollment I’ve ever seen if agents will pick up the right products.”

She noted that agents are required to tell consumers what their products do not do. A lot of the agent population will go through a disclosure with a client but do not explain it properly, she said.

“If they say, ‘I have a solution for this and I can build you protection that is guaranteed renewable,’ you have a great opportunity,” she said.

It’s important to present both ACA and non-ACA options to clients, said Cruz.

“We wanted to reimagine the ACA, so we created zero-dollar-deductible plans and got rid of out-of-pocket caps,” he said. “There are so many gaps between ACA and non-ACA products, and products will come along to fill the gap.

“We must break the narrative that this is not junk insurance – it’s a better option than ACA and consumers have better options out there at less cost.”

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].