A discussion with Joe and Wesley from Evensun Health

It’s been a roller coaster of a year for ACA plans since Centene withdrew their 2025 guidance this past summer. Now with the government shutdown over the enhanced advanced premium tax subsidies as open enrollment starts, it feels like the theme for 2026 is uncertainty: Aetna’s exiting the exchanges while on earnings call this quarter UnitedHealth Group, Centene, and Molina are all talking about shrinking their footprint and trying to price higher than their competitors to avoid a winner’s curse situation.

To get a better sense of what went wrong this year and how payers are thinking about the market in 2026, we spoke with the ACA experts Evensun Health about where the surprise elevated medical trend came from in 2025, the game theory of insurance pricing, risk adjustment receivables, and what they would recommend states do to help stabilize their marketplaces.

00:00 Introduction

00:46 Current Market Trends and Cost Drivers

06:18 Impact of Enhanced Premium Tax Credits

11:35 Carrier Profitability and Market Dynamics

26:17 State-Level Solutions and Future Outlook

30:14 Conclusion and How To Get In Touch