Organization says new ACA marketplace policies shift more costs and complexity onto patients and families

Queens, NY – May 20, 2026 – Last Friday, the Centers for Medicare & Medicaid Services finalized the federal rule governing Affordable Care Act marketplace insurance plans for 2027. Undue Medical Debt warns that these changes will leave more Americans underinsured, burdened by higher out-of-pocket costs and vulnerable to medical debt.

In response to these rules, Undue Medical Debt President and CEO Allison Sesso issued the following statement:

“Health insurance premiums are too high, and we appreciate the administration’s efforts to identify pathways to reduce that monthly cost. But these changes risk making America’s medical debt crisis even worse.

“Americans are already struggling to afford healthcare, and many are going into debt just to get the care they need. Families face rising costs for groceries, housing, childcare and transportation — and still healthcare affordability is the top issue for 61% of Americans, even above the economy.

“At first glance, some of these changes may appear to make coverage more affordable. But here’s what we know from relieving medical debt for more than 27 million families: cheaper monthly premiums lead to medical debt.

“Patients need coverage they can count on. These changes shift more financial risks to patients by forcing them to pay thousands out of pocket or requiring them to comparison shop while they are sick or injured. These are unreasonable expectations that set people up for failure.

“Amber, a mother in Ohio, fell into medical debt while caring for her daughter’s chronic kidney disease despite having insurance. After taking a lower-paying job during COVID, her family ended up in a high-deductible plan that left them struggling to afford ongoing care and testing.

“For many families, choosing a premium they can afford leaves them exposed to high deductibles they can’t. These policies are simply shifting costs onto families like Amber’s when they’re sick or injured, leading to financial disaster.

“We are especially concerned about the expansion of catastrophic health plans. By design, these plans come with very high deductibles, meaning people must pay thousands out of pocket before most coverage kicks in. These plans look cheaper but can expose families to overwhelming and unpayable medical bills later.

“As younger and healthier folks pick skimpier coverage or forgo health insurance entirely because of the cost, older Americans and those with chronic illnesses will face even higher premiums as a consequence.

“We are also deeply concerned about changes that make coverage harder to navigate and access. Eliminating standardized plans will make it more difficult for families to compare options and understand what they’re buying. New, non-network plans put navigating our healthcare system squarely on patients’ shoulders, increasing the risk of surprise bills and financial hardship.

“Taken together, these changes will push more people into plans that don’t protect them — and increase the likelihood that people will delay care, skip medications or fall into debt when they get sick.

“Across the political spectrum, Americans agree that insurance should protect them from medical debt. We urge policymakers to focus on solutions that truly protect people from financial ruin when we get sick, like expanding current drug price negotiation efforts. This rule moves us further away from that goal.”

About the 2027 Marketplace Rule

The final 2027 Notice of Benefit and Payment Parameters (NBPP) governs how Affordable Care Act marketplace plans will operate starting in 2027.

Undue Medical Debt is concerned the rule will make coverage harder to navigate and increase the risk of medical debt for patients. Key changes include:

• Eliminating standardized plan options making it harder for patients to compare plans and understand what services and costs are covered.

• Expanding eligibility for catastrophic coverage and allowing higher cost sharing for bronze plans which will shift people into coverage that fails to protect them from medical debt when they need it with some bronze family plans having out-of-pocket maximums over $30,000.
  • These plans are also likely to attract younger and healthier people who are willing to gamble that they won’t get sick — and siloes sicker and older folks in more expensive plans that will cost them more.

• Allowing new “non-network” plan designs that allow insurers to operate without provider networks, making it harder for patients to find providers and understand what they’ll need to pay when they seek care.

• Ending year-round enrollment for many low-income individuals (those under 150% of the federal poverty level). Many of these individuals will be left uninsured and the cost of their care will shift to hospitals and emergency rooms.

• Adding new income verification requirements, requiring upfront payment and red tape that could delay or prevent people from accessing coverage and financial assistance.

To learn more, read the comments Undue submitted in response to the proposed rule (link downloads PDF).