July 2026 Issue — Why More Americans Are Looking Beyond Traditional Insurance This Year

If you've felt sticker shock renewing your ACA marketplace plan this year, you're not imagining it — and you're not alone. 2026 has turned into a pivotal year for the case we've been making in this newsletter all along: the traditional system is pricing people out, Washington is (slowly) waking up to the cost of opacity, and the free-market alternatives — medical cost sharing, transparent pricing, and group plans built on an individual chassis — are stepping into the gap faster than ever.

Here's what happened this year, and what it means for you.

The ACA Premium Shock Is Real

The enhanced premium tax credits that had artificially suppressed marketplace premiums since the pandemic expired on January 1, 2026 — and the bill came due immediately.

By the numbers:

• Unsubsidized benchmark premiums jumped 26% on average in 2026, the largest single-year increase in eight years.
• Average monthly premium payments for subsidized enrollees rose 58%, from $113 to $178 — and that's after many people downgraded to cheaper bronze plans with higher deductibles just to soften the blow.
• The share of marketplace enrollees receiving any premium tax credit fell from 92% to 87% — the first decline since 2020.
• Adults aged 50–64 got hit with what analysts are calling a "double whammy": many lost subsidy eligibility entirely while also facing the steepest unsubsidized premium increases of any age group.
• Up to 4 million people are projected to lose coverage entirely as a result.

What this means for you: if you've defaulted to an ACA marketplace plan year after year because it was simply the obvious, lowest-cost choice, that assumption is worth revisiting. For a lot of people — especially healthy individuals and families who don't qualify for much (or any) subsidy — a marketplace plan is no longer automatically the cheapest or best-fitting option. It's worth comparing what you're paying now against the alternatives covered in this issue before you assume your renewal notice is your only path forward.

Washington Is Finally Talking About Price Transparency — With Some Teeth

On June 10, the House Energy and Commerce Subcommittee on Health held a hearing titled "Lowering Health Care Costs for All Americans: Examining Policies to Increase Health Care Transparency," weighing three bills: the Lower Costs, More Transparency Act; the Patients Deserve Price Tags Act; and the CHECK Act. A Brown University health policy researcher testified that hospital consolidation and private-equity acquisition of physician practices keep driving up patient costs without improving quality — and urged the committee to support all three.

Separately, the administration has been sending warning letters to hundreds of hospitals that still aren't posting real, usable prices, with fines on the table for continued noncompliance. Hospital groups are pushing back, arguing regulators should evaluate whether the existing rules are working before piling on new ones — a fair point, but also a reminder of how slowly institutional transparency moves compared to what consumers actually need today.

The bigger picture: transparency legislation is a long game. In the meantime, the tools that already give people real, upfront pricing — direct primary care, cash-pay arrangements, and cost-sharing communities — remain the fastest way to actually shop for care like a consumer.

Private Group Health Plans Are Getting A Real Push In Washington

This is the one to watch closely. Private group health plans — true group coverage built on an individual chassis through associations, sold under ERISA rather than ACA rules, and requiring health questions to qualify — have always offered something the ACA marketplace can't: real underwriting.

That means healthy applicants get rewarded with lower premiums instead of subsidizing the sickest people in a community-rated pool. Some of these are full major medical plans with the same kind of contractual claims guarantee you'd expect from traditional insurance; others are limited-benefit designs meant to supplement other coverage rather than replace it. Either way, they've historically lived in a bit of a regulatory gray zone — and that's starting to change.

The practical difference worth knowing: unlike medical cost sharing, where members voluntarily share each other's bills with no contractual guarantee of payment, a true major medical private group plan is a binding insurance contract. You go through underwriting up front — answering health questions, sometimes a short questionnaire, occasionally records review — and in exchange you get the certainty of a real claims process. For some people that trade-off (a bit more underwriting friction for contractual certainty) is worth it; for others, the flexibility and lower cost of cost sharing wins out. Knowing both options exist is the point.

What's happening:

• In December 2025, the U.S. House passed the Lower Health Care Premiums for All Americans Act (H.R. 6703) on a 216–211 vote. The centerpiece of the bill is expanding association health plans — codifying and broadening the 2018 AHP rule that had been tied up in litigation and was ultimately rescinded by the Department of Labor in 2024.
• That matters because the legal footing under association-based, ERISA-governed plans has been shaky for years — the original 2018 rule was struck down in court in 2019, and the rescission in 2024 left the whole category operating without a clear, durable federal framework.
• The bill is currently sitting in the Senate, where it faces a steep climb — it would need Democratic votes to reach 60, and most coverage suggests it's not expected to advance as written. But the fact that expanding AHPs is now the House GOP's flagship answer to the ACA premium spike tells you where the policy winds are blowing.
• Small business groups like NFIB are actively lobbying the Senate to pass it, citing decades of small employers ranking health costs as their top concern.

What it means for you: Even without new federal action, private group/association plans remain available today in all states except Washington if you can answer the health questions. With ACA premiums up 26%+ for healthy, unsubsidized people, the gap between a medically underwritten group plan and a community-rated marketplace plan has rarely been wider. If you've been leaning toward cost sharing but want the certainty of a contractual major medical plan instead, this is worth a conversation — and if Congress eventually gives the category firmer legal ground, it'll only get more competitive from here.

Medical Cost Sharing: The Case Just Got Stronger — Including For People Who Used To Be Subsidized

If you're already on Zion HealthShare, Sedera, or a similar program, none of this is new to you — you made the move to cost sharing because the math worked, and that hasn't changed. What has changed is who else the math now works for.

Health care sharing programs continue to add members nationwide, with estimates now ranging from roughly 1 million to 1.5 million participants and more than 100 ministries certified by Health and Human Services (HHS). One major cost sharing organization actually cut its suggested monthly share amounts by up to $26 across its three most popular programs last fall — a rare thing to see in any corner of healthcare right now. More people are discovering what you already know.

Here's the part worth paying attention to this year: for a long time, the obvious comparison for cost sharing was an unsubsidized ACA plan — and cost sharing usually won. But with the enhanced premium tax credits gone as of January 1, a lot of people who used to have a heavily subsidized, low-premium ACA plan are now paying close to full price for the first time. That changes the comparison for them too. If you know someone — a family member, a coworker, a friend — who just got hit with a much higher ACA renewal and used to think subsidies made their marketplace plan untouchable, this is the year to point them toward a real cost-sharing quote instead of assuming the marketplace is still their cheapest option.

As always, it's worth being clear about what these programs are and aren't. They aren't insurance, there's no contractual guarantee of payment, and most exclude pre-existing conditions and some preventive care. For healthy individuals and families now facing real, unsubsidized costs for the first time, though, the value proposition has rarely been more obvious.

The Bottom Line

Three things are true at once right now: traditional ACA coverage got a lot more expensive, the push for real price transparency is gaining political momentum (even if slowly), and the free-market alternatives we cover every month are reaching more people than ever — including a whole new group of formerly-subsidized ACA enrollees who never had reason to compare before. If you're wondering whether your renewal notice is really your only option, it isn't. And if you know someone whose subsidy just disappeared or whose net ACA premium has increased substantially, send them our way — it's worth ten minutes to find out what they'd actually pay.

Have questions about private group health plans, medical cost sharing, or how to shop for transparent pricing in your area? Send us an email or give us a call. And if someone in your life just got a brutal ACA quote, feel free to forward this along — we're happy to run a free comparison for them.

Paul Cholak

786-970-0740 (cell)

pcholak@controlyourhealthcarecosts.com (email)

Sources: KFF, AJMC, Congressional Budget Office, Congress.gov, NFIB, U.S. Department of Labor, Brown University, AHA, PBS NewsHour, Managed Healthcare Executive

Contact Us

Local: 561-734-3884

 Toll-free: 877-734-3884

pcholak@controlyourhealthcarecosts.com