During the upcoming open enrollment season for Medicare Advantage (MA), a record 28 percent of MA members are expected to switch plans, driven by payers cancelling unprofitable plans and paring back benefits. The loss of supplemental benefits is even inspiring some enrollees to leave MA for traditional Medicare, with MA’s share of Medicare enrollment projected to fall from 50 to 48 percent next year. The largest MA payers are pivoting from membership growth to margin control because rising medical costs and slowed federal reimbursement growth have taken the wind out of MA’s profitable sales. CVS-Aetna and Humana have led this charge since 2024, while payers like UnitedHealth Group (UHG) are playing catchup by promising to cut 600K members’ plans in 2026, after picking up too many members shed by Aetna and Humana in the year before. Although fewer plan options could be a problem for MA beneficiaries, the individuals and small businesses purchasing insurance on the Affordable Care Act exchanges are facing a catastrophe. Average premium increases of 18 percent are the result of higher utilization and medical costs hitting at the same time as the expiration of enhanced subsidies. For a family of four making $85K, the premiums they pay each month could go up by 94 percent, unless Congress acts to extend the enhanced subsidies. The expiration of these subsidies could cause 2.9M people to lose health insurance in 2026 alone, which is why Congressional Democrats have made it a top issue in ongoing budgetary negotiations to avoid a government shutdown. This crisis can still be avoided, but we are running out of time.