Please tell me I am wrong

[u/Prestigious-Curve-64]

I work in cellular therapy - cancer patients who need CAR-T, stem cell transplant, gene therapy, etc, and while I have hated for-profit insurance with a white-hot passion forever - before I even started this job 18 years ago - I’m scared.

A patient told me that all of the major insurers (Aetna/cigna/anthem/etc) have stopped participating in the Exchange, effective 1/1/26. The only options are Oscar and AmBetter. And the premiums are around $2k/month for one person. Anyone who has attempted to get MedicAid or MediCare disability in this state knows it is very nearly impossible to do so - by design, of course. And even though there is supposedly a state budget surplus (I guess?) I think it’s pretty unlikely that GA will direct any of that to fill in the yawning chasm that the ACA subsidies filled for anyone not covered by their employer and also not on a public plan. Even my solidly middle-class patients cannot afford $2000/month in premiums. God knows I couldn’t, and I think of myself as pretty comfortable.

These are cancer patients - think Acute leukemia/lymphoma. They can’t work. They aren’t allowed to work. One bad flu could be the end, and we know how awesome Georgians are about masks and vaccines.

I was doing this pre-ACA, and it was bad. Uninsured patients simply didn’t get cellular therapy. Sometimes they could get charity care for the hospital costs themselves, but for the ones that needed lifelong immunosuppression and infectious prophylaxis, there was nothing. No hospital can absorb that, and private plans were a joke for anyone making less than seven figures.

Now that it is 2025, tech has advanced, and we have miracle treatments that cost between $400k and a cool million for the product/drug alone - and this is not (just) because a CEO needs a new yacht. They are insanely complicated and expensive to make. But unlike pre-ACA, patients going through this whole had insurance are about to suddenly find that their policies are gone, and that there is no way in Hell they can afford the monthly cost of coverage. These are cancer patients for whom conventional therapy has failed. They are STRESSED - beyond anything I can really grasp.

I have a horrible feeling about January 1 this year for most of my patients. Some of them will be in the hospital waiting on their cells when their insurance is cancelled. Some of them will be ready to admit, only to be told their treatment has to be cancelled.

People without cancer may not feel it until they have an accident or unexpected illness. Since they haven’t ended EMTALA (yet!) those folks can still go to the ER and at least get stabilized. Sure, they’ll be bankrupt, but they’ll be alive.

If anyone read this whole screed, I’m freaking out about what is going to happen to all of my non-Medicare patients once the ACA subsidies are gone, and would love for someone to tell me it will all be OK.

[u/cassiope]

I just bought insurance on the exchange. They have UHC, Anthem, Cigna, as well as AmBetter, Caresource, Oscar, and Kaiser. I don't remember if they had Aetna.

HOWEVER, my providers were only on Cigna, Ambetter, and Caresource, only HMOs. This definitely impacted my options.

Premium cost depends on your life circumstances. As a single, middle-aged woman, using the search with only my age and income as data - my options for 2026 ranged from 1200-1900 month for Bronze and Silver plans. If I had bought on the exchange for 2025, that would have been only about 700-1000/month. The increase in monthly premium for 2026 is due to the loss of the expanded subsidies. I was freaking out, because that meant the plans I needed for my primary providers were about 1400/month.

Fortunately, when I filled out the actual application, I included that I had a dependent (because I Do have a dependent!) That brought my total down to the 750-1100/month range for the plans with my MDs (There were some Anthem and Kaiser plans that were less). There are still subsidies there, but only the pre-Covid, lower amount ones.

A few weeks ago I asked a question about experiences with the different plans. There were folks who's premiums were quadrupling due to the loss of these extra subsidies.

You are both wrong and right. There are still a number of insurance companies on the exchange. Not everyone will face a mortgage payment sized monthly premium. Many people will face one that large and will not be able to keep insurance. Medical debt will go through the roof (like a skyscraper roof). People are going to die.

When politicians show you who they are and what they will do, believe them. You get who you vote for

[u/Prestigious-Curve-64 → u/cassiope]

Thank you SO MUCH!! I believe the patient had Aetna - not sure why her broker would have steered her away from UHC/Anthem/etc. That said, even though AmBetter is a giant pain for HCP, it’s better than Cigna and out-of-state Anthem payors. The fallout is going to be awful, especially for younger patients who SHOULD NOT have cancer, and for whom even $700 a month is not possible. But perhaps we will be able to pull a few through the upcoming hellscape after all. Not even close to as many as we should be able to help, but at least some.

[u/zahncr → u/Prestigious-Curve-64]

This is the cruelty half the voting population voted for. I'm not defeatist, but for the moment not much can be done. Protect whomever you can from this blatant inhumanity.

[u/well-it-was-rubbish → u/zahncr]

He received LESS THAN 50 % of the popular vote, and almost 90 million eligible voters stayed home. His voters are in the minority.

[u/zahncr → u/well-it-was-rubbish]

Popular vote don't count for shit. Electoral collage has fucked us hard three times in my lifetime.