Where Did Three Million Patients Go?

Nearly three million Americans have left Affordable Care Act (ACA) Marketplace coverage during 2026, according to recent Reuters reporting. Those patients did not stop needing healthcare. Some moved to employer or other traditional coverage, while others turned to short-term plans, health-sharing arrangements or self-pay. Some may simply be going without insurance. 

At the same time, the patients who remained in the Marketplace increasingly selected plans that leave them responsible for more of their healthcare costs. 

Key numbers 

• ~3 million: people left ACA Marketplace coverage in 2026 (Reuters) 

• +37%: average Marketplace deductible, $2,759 in 2025 to $3,786 in 2026 (KFF) 

• 40%: of Marketplace selections were Bronze plans, up from 30%; silver fell from 57% to 43% (KFF) 

• ~19%: increase in the self-pay share of units across our own client data 

For anesthesia practices, these changes may be creating two very different problems: patients who have surgery but become more difficult to collect from, and patients who postpone elective surgery altogether. 

The Patient Has Insurance. The Patient Also Has the Bill. 

Anesthesia groups generally do not interact with patient responsibility the way a hospital, ASC or surgeon’s office might. We typically are not collecting the patient’s deductible or copayment before providing anesthesia. In many cases, the anesthetic is delivered first, and the group’s financial exposure becomes apparent only after the claim is submitted and adjudicated. 

A patient can therefore arrive with active insurance, receive anesthesia and subsequently have much of the allowed amount applied to a deductible. With the average Marketplace deductible now approaching $3,800, a claim can be completely clean and process exactly as expected while producing relatively little immediate payment from the insurer. The problem is that the patient is now the payer. 

What We Are Seeing In Our Own Data 

Our client data points in the same direction. Across a sample of 30 Coronis anesthesia clients, self-pay made up 2.8% of total units so far in 2026, up from 2.3% in 2025, an increase of about 18% in the self-pay share. 

Some Patients May Never Reach the OR 

There is another side to higher patient responsibility that may be even more important. Patients facing thousands of dollars in deductibles do not always proceed with elective care. KFF reports that: 

• 28% of insured and uninsured U.S. adults say they skipped or postponed needed healthcare because of cost during the past year 

• 62% of uninsured adults under age 65 say the same 

• ~30% of insured adults ages 18–64 reported postponing or skipping needed care because of cost 

What These Numbers Tell Us 

28%: cost is already a common barrier. More than one in four U.S. adults skipped or postponed needed care because of cost in the past year. 

62%: losing coverage changes behavior. Uninsured adults under 65 delay care at more than twice the rate of insured adults (62% vs. about 30%). 

~30%: insurance is not a full shield. About three in 10 insured adults ages 18–64 still delay care because of cost; so, having coverage does not always mean getting care. 

Why it matters for anesthesia: as Marketplace members move into higher-deductible plans or go without coverage, more patients may fall into the groups most likely to postpone care. A postponed elective procedure is an anesthesia case that never happens. 

Research on high-deductible health plans points the same way, with patients delaying or foregoing operations and procedures because of cost. In one study, the share of families who delayed or went without an operation or procedure was: 

• Lower-income families: 19.8% 

• Higher-income families: 6.0% 

Families with high-deductible plans, by income level. 

That has a different implication for anesthesia. A patient who postpones a screening colonoscopy, elective orthopedic procedure or other scheduled intervention because of a large deductible does not generate a difficult anesthesia receivable. That patient never generates an anesthesia case, which results in a reduction in case volume for anesthesia groups. 

Pressure From Two Directions 

Nearly three million people leaving ACA plans is not simply an insurance-market statistic. Combine those departures with patients switching coverage and Marketplace deductibles increasing by more than $1,000 in one year, and anesthesia practices may feel the effect from two directions. 

1. The patient has the surgery

The anesthesia group may discover only after billing that a larger portion of the allowed charge belongs to the patient. 

2. The patient waits

The patient looks at the premium, deductible and expected out-of-pocket expense and decides that an elective procedure can wait. 

What to Expect Through the Rest of 2026 and Into 2027 

Rest of 2026 

• Patient responsibility stays high: the average Marketplace deductible is $3,786 on 2026 plans. 

• CMS is expected to finalize the 2027 Medicare fee schedule in November. The proposal lowers anesthesia conversion factors by about 0.9% to 1.4%. 

• Most calendar-year deductibles reset on January 1. 

January 2027 

• Medicaid work requirements begin for expansion adults ages 19 to 64. People who lose or are denied Medicaid because of them are not eligible for Marketplace premium tax credits. 

• Marketplace insurers have proposed a median 14% premium increase for 2027, after steep increases in 2026. 

Through 2027 

• More patients may arrive underinsured or uninsured. Congressional Budget Office (CBO) projects work requirements alone will add 4.8 million uninsured people by 2034. 

• Self-pay balances and cost-driven delays in elective care may continue to grow. 

The patients haven’t stopped needing healthcare. But how they are insured, how much they must personally pay and whether they can afford to proceed are changing, and the pressures behind that shift look set to continue into 2027. 

For anesthesia, one patient may become harder to collect. 

The other may never become a case at all.