Enhanced ACA premium tax credits expired at the end of 2025, and insurers are pulling back from the ACA marketplace while enrollment composition shifts toward high-deductible bronze plans. Now, the knock-on effects of these moves are beginning to emerge as leaders from the largest for-profit health systems elaborated on first-quarter results. The turbulence reflects a broader structural unraveling of the ACA marketplace that is accelerating this year and as major payers pull back coverage, shrink service areas or exit the ACA entirely amid mounting financial losses.

UnitedHealthcare to reduce prior auth requirements by 30%

UnitedHealthcare announced Tuesday that it will further ease prior authorization requirements for a slew of services.  The insurance giant said it would eliminate authorization requirements for 30% of services that previously required payer approval. The company said it plans to roll out the changes by the end of the year, with services included ranging from certain outpatient surgeries to diagnostic tests like echocardiograms to chiropractic care.

‘Dynamics we haven’t experienced before’: Hospitals absorb costs as patients lose coverage, skip Medicaid

Hospitals are confronting a new and unexpected pressure point in 2026: Fewer patients losing coverage are transitioning to Medicaid.  The slowdown, emerging alongside ACA exchange attrition, is adding to uninsured volumes and complicating payer mix assumptions for some of the nation’s largest for-profit health systems.  With insurers exiting ACA markets, enrollment shifting toward plans with higher patient cost-sharing and Medicaid conversion rates softening, hospitals are facing a growing share of patients with limited or no coverage.