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💥 Everyone calls the ACA enrollment crash a fraud story.
The people who left did not commit fraud. They just ran out of money.
📰 According to KFF Health News, ACA plan enrollment continues to drop after Congress allowed enhanced ACA subsidies to expire. Insurers say they are expecting to hike premiums even more next year. And many Americans are publicly saying they can no longer afford coverage. The Trump administration, for its part, attributes the enrollment drop to a crackdown on fraud.
🎯 That framing is a political escape hatch, and I am done watching people accept it. When the price of something doubles and people stop buying it, we do not call that a demand problem. We call it a pricing problem. Congress made a deliberate choice to let those subsidies expire. Americans are not disappearing from the rolls because they were gaming the system. They are disappearing because the math stopped working for them.
📊 Here is what makes this worse. Insurers are not absorbing the loss. They are passing it through and then some. Enrollment drops, the risk pool gets sicker, premiums climb, more people drop off, premiums climb again. This is not a market correction. It is a spiral. And every insurer announcing next year’s hike is, in effect, announcing that the people who just got priced out made the right call. You cannot afford this. We agree. Please exit.
🤔 The counterpoint I hear: premiums were rising before the subsidies expired, and some of the enrollment gains were driven by loose eligibility rules that let people who did not qualify slip through. Fine. I will grant there was noise in the enrollment data. But that is an argument for tighter verification, not for letting the whole subsidy structure collapse and then blaming the fallout on the people who left. You do not fix a leaky faucet by demolishing the plumbing.
🏥 Meanwhile, KFF Health News also reports that Republicans and some Democrats on Capitol Hill are now taking aim at nonprofit hospitals, questioning whether they are delivering enough community benefit to justify their tax-exempt status. That is a fight worth having. But if we are asking hospitals to prove their community value, we should also be asking what community value looks like when the people those hospitals are supposed to serve have just been priced off their insurance.
🔥 Coverage is not a privilege you earn by being a low enough fraud risk. It is the floor of a functioning healthcare system, and right now we are actively sawing through it.
❓ To every CFO at a major insurer announcing premium hikes for next year: at what enrollment number does this become your problem too, not just the patients’?
👉 Follow Jonathan Govette, CEO of Oatmeal Health, for daily healthcare insights on LinkedIn. Deeper dives in The Oatmeal Bite on Substack: https://news.oatmealhealth.com
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Author:
CEO/Co-Founder @ Oatmeal Health | AI Lung Cancer Screening | Almost Became a Doctor | Engineer | Follow to Share What I’ve Learned Along the Way
I help patients get the care they need earlier, preventing late-stage cancer.
That’s been the throughline across three companies and almost 20 years in healthcare. At ReferralMD, we fixed broken referral networks so patients didn’t fall through the cracks. At Oatmeal Health, it’s lung cancer: building the diagnostic and screening infrastructure so the 85% of cases caught too late get caught early instead.
Today as CEO of Oatmeal Health, I lead a team embedding AI into radiology workflows to turn routine lung CT scans into reimbursable cancer risk assessments. We partner with FQHCs to reach underserved communities, and with health systems and payers to make early detection economically sustainable. Think HeartFlow or Cleerly, but for lungs.
Between companies, I advised at Techstars and Plug and Play, mentoring founders building in digital health. That experience shaped how I think about what separates companies that ship from companies that stall: distribution, reimbursement, and clinical trust, not just technology.
I’m a CancerX alumnus, a 3x healthcare founder, and someone who believes the biggest problems in cancer aren’t scientific. They’re operational.
We’re hiring mission-driven builders at Oatmeal Health. If you want to work on something that matters, reach out.
When I’m not working, I’m traveling, mentoring, and keeping up with one very energetic husky. 🐾
Substack – The Oatmeal Bite:
Millions of patients get less care because of who they are, where they live, or how they look. I’m fighting to change that. CEO @OatmealHealth, a startup built for the underserved. The Oatmeal Bite: intel for clinicians, investors, and advocates.
Jonathan Govette
CEO of Oatmeal Health
Substack:
https://oatmealhealthjonathangovette.substack.com/
