Aetna Exits ACA Marketplaces as CMS Launches Fraud Center and Milken Advances Women's Health
In 2026, CVS Health's Aetna will withdraw from the Affordable Care Act (ACA) individual marketplaces across 17 states, affecting around one million enrollees who will need to seek alternative coverage. This marks Aetna’s second exit from ACA markets in the past decade, highlighting ongoing challenges insurers face in ACA exchanges. Meanwhile, the Centers for Medicare & Medicaid Services (CMS) has established the Fraud Detection Operation Center (FDOC) to enhance efforts against waste, fraud, and abuse within federal healthcare programs, including targeting improper ACA plan enrollments and fraudulent billing practices.
California's ACA marketplace, Covered California, is confronting potential federal spending cuts that could impact health coverage and vaccination rates. Covered California currently serves nearly two million residents with most receiving federal subsidies, notably expanded in 2021 to include many middle-income households. This subsidy expansion fueled enrollment growth in ACA exchanges nationwide, emphasizing the significance of federal policy shifts on marketplace stability.
In parallel healthcare developments, the Milken Institute is launching a Women’s Health Network chaired by former First Lady Jill Biden. This initiative aims to unite stakeholders across research, business, policy, and patient advocacy to advance understanding and treatment of conditions predominantly affecting women, such as Alzheimer’s disease and heart disease. Additionally, significant operational changes are occurring in healthcare providers, including the permanent shutdown of Crozer Health System's main facility in Delaware County and Banner Health's acquisition of VillageMD clinics in Colorado, integrating them into its system alongside provider and staff transfers.
Behavioral health system reforms are underway in Montana, with lawmakers approving $124 million to revamp and expand services, improve facilities, and adjust commitment procedures. This funding aims to address previous budget-related service reductions, waitlists, and lost federal certifications. Meanwhile, Boston Medical Center announced it will rebrand two Massachusetts hospitals after acquiring operations, and UF Health and United Healthcare reached a multi-year contract restoring network access to UF Health patients.
These events reflect ongoing shifts and adaptation within the U.S. healthcare and insurance sectors influenced by regulatory, market, and operational dynamics. Key themes include insurer market withdrawal, regulatory enforcement against fraud, public health funding challenges, healthcare system consolidations, and targeted investment in women's health and behavioral services. Such changes have significant implications for payer-provider relations, marketplace offerings, healthcare accessibility, and policy compliance.