Cigna will pull out of Affordable Care Act exchanges in 2027, the insurer confirmed Thursday, deepening the instability roiling the individual market after federal enhanced subsidies expired.
Executives disclosed the decision during Cigna’s first-quarter earnings call, where the company posted a better-than-expected net income of $1.7 billion. Cigna is the second major insurer to exit the ACA marketplace, following CVS’s Aetna, which stopped offering plans for this year.
“We did not make this decision lightly, and appreciate the importance of ensuring patients have continuity through the transition,” said Brian Evanko, Cigna’s president and incoming CEO. He added that the company saw no “clear path” to scale its ACA business to a size that would meaningfully impact the bottom line.
For Cigna, the ACA business is a small slice of its portfolio. The exit affects 369,000 members across 11 states—a fraction of the company’s total 18.3 million members. But enrollment has been sliding: down 17% from 446,000 in the first quarter of 2025 to 369,000 in the same period this year. “This is small business for us today, and it’s been shrinking in recent years,” Evanko said.
The broader ACA marketplace has contracted sharply after Congress failed to extend enhanced subsidies that reduced premiums for lower-income enrollees and capped costs for those earning roughly $63,000 or less. Initial sign-ups dropped by about 1.2 million people, and analysts expect further erosion as more enrollees face unaffordable bills.
The Trump administration has attributed the enrollment decline to a crackdown on fraud, arguing that those dropping coverage were never legitimately enrolled. But insurers must now price in that uncertainty, likely driving premiums higher. The most cost-sensitive policyholders—often younger and healthier—are the first to leave, leaving a sicker, more expensive risk pool that forces further rate increases.
While the exits of Cigna and Aetna have not triggered the kind of crisis seen in 2017, when some counties had zero ACA plans, the political fallout is mounting. Affordability and healthcare costs remain top voter concerns, and the issue is expected to feature prominently in the midterm elections. Trump’s use of an Iran ceasefire to sidestep the War Powers Act has drawn attention away, but Democrats have already hammered Republicans for failing to extend subsidies.
“Democrats will intensify these attacks as November approaches,” said one strategist familiar with the party’s messaging. The loss of enhanced subsidies has become a central campaign issue, with Democrats arguing that GOP inaction is leaving millions without affordable coverage.
As insurers recalibrate, the ACA marketplace faces an uncertain future. Cigna’s departure underscores the fragility of a system that, without sustained federal support, may struggle to retain both insurers and enrollees.
