Cigna Discovers Healthcare Can Grow Faster Without All Those Patients

Americans shopping for Affordable Care Act coverage for 2027 are facing proposed premium increases and departures by insurance companies. NBC News reports that 11 insurers plan to leave at least some state marketplaces, while six plan to enter new ones. Cigna is leaving all 11 states where it offers ACA plans, covering more than 350,000 people.

Those aren't all the same markets. You can't subtract six from 11 and announce that every American has lost five insurers. Geography remains inconveniently real.

But the overall direction is not reassuring for a system whose sales pitch involves shopping around.

Welcome to the marketplace. Several stalls have left. The remaining merchants would like to discuss how much more expensive the apples are, except the apples determine whether you can keep seeing your oncologist.

Cigna's explanation points to CEO Brian Evanko's comments about positioning its core healthcare businesses for sustainable growth.

Sustainable growth. By leaving.

I understand that businesses withdraw from markets. I understand that profitability matters to a company. I am simply admiring the extraordinary botanical achievement of growing a healthcare business by pulling it out of eleven states. Most plants don't get to call that spring.

And this isn't happening in a vacuum. Enhanced ACA tax credits expired at the end of 2025. NBC reports enrollment subsequently fell by roughly three million. Some healthier people moved to cheaper, worse coverage or dropped insurance. Those remaining tended to need more care, raising costs and making the business less attractive to insurers.

Standard ACA subsidies still exist. The enhanced assistance expired. Important distinction. We should be precise about which piece of the bridge was removed before admiring the new river access.

Because WHO thought this sequence would improve anything? WHO? Make coverage harder to afford, watch healthier customers leave, then discover that the people still buying health insurance have an inconvenient interest in healthcare?

What a shock. The remaining customers include people who need the product. Alert the business school. Put a tarp over the statue of the invisible hand.

Insurers are proposing average premium increases of about 15 percent for 2027. That's an average proposal, not a final increase on everybody's bill. Actual options and costs vary. The bad news does not need an exaggeration department.

It already has a billing department.

YOU CANNOT BUILD A HEALTHCARE SYSTEM AROUND SHOPPING AND THEN ACT SURPRISED WHEN PEOPLE NOTICE THE SHOPS ARE FUCKING LEAVING.

And the consequences aren't limited to learning a new company logo. A different plan may mean a different doctor network. A patient can do everything right, pay the premiums, attend appointments, keep the paperwork, and still have to investigate whether next year's insurance recognizes the doctor who knows what's wrong with them.

The insurer gets a strategic transition. The patient gets homework with medical consequences.

I need to lie down. Preferably somewhere that doesn't require checking whether lying down is covered in my county.

The ACA can remain on the books while getting harder to use. Health-policy researcher Miranda Yaver warns in the NBC report that this upheaval could weaken the law without Republicans having to repeal it. That's a warning about where these pressures can lead, not proof of a secret plan behind every company's decision.

But listen to how low the political bar can get: the program still exists. Congratulations. The library still exists too if you leave the sign up and remove half the books. Technically, a building. Bring your own reading.

And then, and THEN, the people defending this arrangement can keep talking about choice as if the word itself schedules an appointment.

CHOICE IS NOT A DECORATION YOU HANG OVER AN EMPTY COUNTER.

Lawmakers and insurers can explain the financial pressures. They should. Those pressures are real. So are the people expected to absorb every adjustment while the powerful call the adjustments necessary.

If your healthcare business grows by leaving patients behind, don't ask the patients to applaud the gardening.