What Happens When Healthy Clients Are the First Ones to Leave

Insurers are already leaving, and Mike Smith explains what that means for who's left.

Aetna just walked away from the entire ACA marketplace, its second exit from the exchanges in a decade, affecting roughly a million people. Cigna is leaving too, taking almost 400,000 more people with it. At least a dozen other insurers have made the same call for next year. It's not a pricing adjustment. It's carriers deciding the math no longer works.

Mike Smith President Emeritus of The Brokerage Inc., who's built a career on understanding exactly this kind of market shift, describes what's forming as a two-tier system: technically insured, but priced out of using that coverage. He calls it "catastrophic coverage disguised as comprehensive insurance."

The mechanic behind it comes down to who leaves first. When premiums spike, younger and healthier enrollees are the ones who feel safe going without coverage, and nearly half of the 1.2 million people who left the ACA marketplace between 2025 and 2026 were between 18 and 34. The people who stay tend to be older and sicker, which is a real driver behind this year's premium spike. Insurers end up choosing between raising rates further or exiting altogether, and more of them are choosing to leave.

For your clients, that means fewer plan options, fewer carriers competing for their business, and a renewal conversation that's about more than a number this year. It's about whether their plan even exists next year.

Smith put it simply: it's a whole new world, and clients who don't understand why will need someone to walk them through it.