Soaring deductibles and coinsurance costs could cause big problems for patients with Affordable Care Act exchange plan coverage — except that most patients with ACA exchange plan coverage aren't actually paying much of the big out-of-pocket bills.
Kevin Hammons, the chief executive officer of Community Health Systems, a large hospital company, talked about the patient financial responsibility reality gap problem Thursday, during a conference call with securities analysts.
Premiums for ACA exchange plan coverage are much higher this year than in 2025, and analysts are predicting that final exchange plan enrollment will fall sharply once the grace periods for 2026 coverage payments expire.
The analysts asked Hammons and other company executives how a big drop in ACA exchange plan enrollment might affect Community Health Systems hospital revenue.
Company executives noted that fewer than 5% of the patients have been using exchange plans to pay for care.
Some displaced exchange plan enrollees could buy cheaper individual coverage or get coverage through employers, executives said.
Hammons noted that the amount of revenue Community Health Systems has collected per exchange plan enrollee has been low.
"Our experience has been that much of the utilization of health care exchange patients is in the emergency department, and oftentimes those individuals do not pay their co-pays and deductibles," Hammons said. "Our collection of co-pays and deductibles is very low for that group of patients. So, factoring that in, we don't believe that there is a big headwind from that business being lost."
Community Health Systems held the analyst call to go over its results for the fourth quarter of 2025 with the analysts. The company streamed the call live and posted a recording on its website.
The backdrop: Patients may have mountains of medical debt hanging over their heads, but health care providers recognize that collecting much of the medical debt will be difficult or impossible.
Only 9% of health care providers estimate that they can recover 20% or more of their patients' bad medical debt, according to iVitaFinancial.
What it means: The use of phantom patient financial responsibility requirements in individual and family major medical coverage may be distorting the health care market data flowing to employers, benefits advisors and government policymakers.
That could have a big effect on employers that want to use individual coverage health reimbursement arrangements, or efforts to help workers use employer cash to buy their own individual or family health coverage.
If a shift to ICHRAs leads to a much bigger drop in hospital revenue than employers and ICHRA program designers realize, that could lead to an unexpected decrease in the supply of health care providers.
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