As a solo dev, I’ve been on ACA with my family for the past four years. In my market, a major insurance company is not returning for 2026 and the prices have gone bananas. Our premiums are increasing over 40%, all of our copays are more than doubling, and the deductible is astronomical. In many cases the cash pay price is probably cheaper than the insurance negotiated rate.

I’m the plus side, all bronze plans can contribute to HSAs next year.

We compared individual plans off market, but they’re mostly the same without HSA access or they’re targeting people with specific ailments (e.g. the diabetes plan).

On top of that, consolidation of hospital systems has made wait times for GPs months unless you’re lucky enough to find a cancelation. We have some older Canadian ex-pat friends and it seems like our health system has all of the downsides of socialized systems, plus we get to pay Cadillac prices.

I’m really hoping 2026 is so bad that something breaks enough to resolve some fundamental issues with private health costs, but I’m not naive enough to think it’s likely. ACA was such a monumental gift to someone, but it definitely not individuals who need family coverage.

For one thing, as I understand it, the ACA was pretty effectively sabotaged by removing the mandate, which destroys the math that makes insurance work.

Because pre-existing conditions have to be covered, you're free to wait until you have a serious (expensive) condition, then sign up for an ACA plan. And there's no mandate that spreads that risk around to healthy people, so the population is severely skewed.

I have no definitive data on this, but it seems self-evident that the system can't work well.

I’ve used ACA plans off and on for about a decade. They’ve mostly been as good (of not better) than the employer plans we had once or twice.

So my guess is this is heavily state dependent. Maryland as a state isn’t hostile to ACA so I think they have solid plans.

I can also only speak for BlueCross plans.

Prices have jumped, see:

    * https://news.ycombinator.com/item?id=44604365
    * https://news.ycombinator.com/item?id=44989706

Many people that use the Marketplace plans don't have employer sponsored health plans available.

It's because health insurance companies need to pad their profits. Because we have a backward system in the US where profits are extracted by everyone without any competition from a not-for-profit. That's why the idea of a public option is so popular (it was originally a Republican idea until it was decided insurance company profits are more desirable). Personally, I don't think any health insurance company should be for-profit. But the for-profit companies sure as hell should have a non-profit competition with the same bargaining power they do.