Courtney Mroch 已经为健康保险支付了高昂的费用，随后得知她的保险公司 Cigna 将退出田纳西州的《平价医疗法案》（ACA）市场。这位 56 岁的纳什维尔居民患有糖尿病和哮喘，也是一名癌症幸存者。她今年为一份银级计划每月支付 1250 美元，高于 2025 年的每月 850 美元 —— 超过了她家庭的房贷。为了控制成本，她的丈夫参加了一个单独的、非 ACA 计划，费用较低。“谁知道 2027 年会有谁承保我，或者会贵多少，”Mroch 说。
Courtney Mroch was already paying a high price for health insurance when she learned her insurer, Cigna, was pulling out of Tennessee’s Affordable Care Act marketplace. The 56-year-old Nashville resident has diabetes and asthma and is a cancer survivor. She pays $1,250 a month for a silver plan this year, up from $850 a month in 2025 — more than her family’s mortgage. To keep costs down, her husband is enrolled in a separate, non-ACA plan that’s less expensive. “Who knows who will cover me in 2027 or how much more it’ll cost,” Mroch said.
许多美国人即将迎来 ACA 开放注册期，面临保费上涨和可选保险公司减少的可能性。在大多数州，注册期从周日开始，给自行购买保险的人大约两个月时间来比较明年的计划。根据非党派健康政策研究机构 KFF 对全美 50 个州和华盛顿特区保险公司公开文件的分析，提供 ACA 计划的保险公司提议 2027 年平均保费上涨约 15% —— 这是连续第二年出现两位数涨幅。
Many Americans are heading into ACA open enrollment with the likelihood of higher premiums and fewer insurance companies to choose from. In most states, the enrollment period begins Sunday, giving people who buy their own coverage about two months to compare plans for next year. Insurers who offer ACA plans are proposing a premium increase of about 15%, on average, for 2027 — the second straight year of double-digit increases, according to an analysis from KFF, a nonpartisan health policy research group, that looked at public filings from insurers across all 50 states and Washington, D.C.
与此同时，根据 KFF 的数据，11 家保险公司宣布计划在 2027 年退出至少部分目前提供承保的州的 ACA 市场。其中包括 Cigna，该公司将退出其提供 ACA 计划的所有 11 个州，拥有超过 35 万 ACA 参保人。有 6 家保险公司宣布计划进入新的市场。
At the same time, 11 insurers have announced plans to leave the ACA marketplaces in 2027 in at least some states where they currently offer coverage, according to KFF. Among them is Cigna, which will exit all 11 states where it offers ACA plans and has more than 350,000 ACA enrollees. Six insurers have announced plans to enter new marketplaces.
KFF ACA 项目主任 Cynthia Cox 表示：“主要结论是，离开市场的保险公司比进入的多。”对于购买保险的人来说，这可能意味着可选的保险公司更少，更多人不得不更换计划。
“The main takeaway is that more insurance companies are leaving the marketplace than coming in,” said Cynthia Cox, director of the program on the ACA at KFF. For people shopping for coverage, that could mean fewer insurers to choose from and more people having to switch plans.
匹兹堡大学健康政策与管理助理教授 Miranda Yaver 说：“这将给人们的医疗和承保带来很多中断。”
“This is going to create a lot of discontinuities in care and coverage for people,” said Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh.
“如果你的医生不接受你可选择的、数量减少的方案，这可能会造成很大的干扰，特别是如果你是患有慢性病的人。”她补充道：“如果可选择的、价格减少的档位不适合你，你还会继续参保吗？”
“If you have a doctor who doesn’t accept the fewer number of options that are available to you, that can be very disruptive, especially if you’re someone who has a chronic illness.”“And if the fewer available price points don’t work for you, are you going to remain covered?” she added.
保险公司为何退出？这些退出发生在增强版税收抵免于2025年底到期之后，导致《平价医疗法案》（ACA）参保人数减少约300万。一些较健康的人转向了更便宜但保障较差的计划，或者完全放弃了保险。留在原计划的人往往健康需求更大、医疗成本更高。德克萨斯州的保险经纪人詹妮弗·钱布利·霍格表示，总体而言，随着医疗成本上升，这可能会使市场对保险公司的盈利能力下降。从消费者角度来看，这意味着“持续的动荡，无论是计划退出、补贴变化，还是医生网络变化，”霍格说。
Why are insurers leaving? The departures come after the enhanced tax credits expired at the end of 2025, leading ACA enrollment to fall by roughly 3 million. Some healthier people moved to cheaper but worse coverage or dropped insurance altogether. Those who remained on their plans tended to have greater health needs and higher medical costs. Overall, that can make the marketplace less profitable for insurers as healthcare costs rise, said Jennifer Chumbley Hogue, an insurance broker in Texas. From the consumer perspective, that means “constant upheaval, whether it’s the plan pulling out or the subsidies have changed or the doctor network has changed,” Hogue said.
在一封电子邮件中，信诺（Cigna）发言人指出首席执行官布赖恩·埃万科4月份的评论，他表示退出ACA市场符合将公司“核心医疗业务定位为可持续增长”的目标。
In an email, a Cigna spokesperson pointed to April comments from CEO Brian Evanko, who said that leaving the ACA marketplace aligns with goals to position the company’s “core healthcare businesses for sustainable growth.”
对一些家庭来说，不断上涨的保费本身就已经迫使他们做出艰难的财务决定。丹尼斯·奥康纳和丈夫在科罗拉多州的月保费今年翻了一倍多，从略高于900美元涨至约2300美元，迫使他们动用了退休储蓄。奥康纳一家也由信诺承保。她计划与经纪人合作寻找另一个计划，但丈夫也在考虑不投保约六周，直到他有资格获得联邦医疗保险（Medicare）。“这让人担忧，”她说。“他很健康，但任何事情随时都可能发生。”
For some families, rising premiums alone had already forced difficult financial decisions. Denise O’Connor and her husband saw their monthly premiums in Colorado more than double this year, from just over $900 to about $2,300, forcing them to dip into their retirement savings. The O’Connors are also covered by Cigna. She plans to work with a broker to find another plan, but her husband is also considering going uninsured for about six weeks until he qualifies for Medicare. “It’s a worry,” she said. “He’s healthy, but anything can happen at any time.”
马克·拉斯罗普住在爱达荷州，在州界对面的华盛顿州经营一家酒庄，他说他和妻子也在寻找新的保障，因为他们的保险公司太平洋资源（PacificSource）决定退出ACA市场。
Mark Lathrop, who lives in Idaho and owns a winery just across the state line in Washington, said he and his wife are also looking for new coverage after their insurer, PacificSource, decided to leave the ACA marketplace.
这对夫妇已经面临更高的费用。他们不符合标准《平价医疗法案》（ACA）补贴的资格，拉思罗普表示，2027年一份可比的计划将花费约17600美元，高于去年的约16000美元。他需要每年做一次核磁共振（MRI）来监测脊髓损伤，费用为2400美元，因此一份免赔额较低的计划很重要。“我们还不知道该怎么办，”他说。在一份声明中，太平洋源保险公司（PacificSource）的一位发言人表示，退出《平价医疗法案》市场的决定并非“轻率做出”，而是为了确保公司能够“在医疗行业日益增长的压力下，继续履行使命并长期为会员提供服务”。
The couple is already facing higher costs. They don’t qualify for the standard ACA subsidies, and Lathrop said a comparable plan for 2027 would cost about $17,600, up from about $16,000 last year. He needs an annual MRI to monitor a spinal cord injury, which costs $2,400, making a plan with a lower deductible important. “We don’t know what we are going to do yet,” he said. In a statement, a PacificSource spokesperson said the decision to exit the ACA marketplace was not “made lightly” and was made to ensure it can “continue fulfilling our mission and serving members for the long term amid growing pressures across the healthcare industry.”
亚弗表示，这些变化可能会削弱公众对《平价医疗法案》的支持。随着参保人数减少，剩余参保者面临更高的费用和更少的选择，市场对消费者的吸引力可能会下降——在特朗普政府和共和党甚至无需废除该法案的情况下，就削弱了该法律。最近凯撒家庭基金会（KFF）的一项民调发现，公众对《平价医疗法案》的整体好感度从64%下降至58%。
Yaver said the changes could undermine public support for the ACA. As fewer people enroll and those who remain face higher costs and fewer options, the marketplace could become less attractive to consumers — weakening the law without the Trump administration and Republicans ever having to repeal it. A recent KFF poll found overall public favorability toward the ACA dropped to 58% from 64%.
“我们没有看到2017年的‘废除并取代’，但我们正让患者更难继续留在这些计划中，”亚弗说。霍格敦促参保者在开放注册期开始时审查他们的选择，而不仅仅依赖邮寄来的通知。她说，他们可获得的保费和补贴可能与信中列出的金额不同。“花五分钟看一看是值得的，”她说。
“We don’t see the repeal and replace of 2017, but we’re making it much harder for patients to remain on these plans,” Yaver said. Hogue urged enrollees to review their options when open enrollment begins, rather than rely solely on the notices they receive in the mail. The premium and subsidies available to them, she said, may be different from the amounts listed in those letters. “It’s worth the five minutes to take a look,” she said.