About 1.3 million people could lose health insurance in 2026 due to marketplace and Medicaid changes in the One Big Beautiful Bill Act, the independent Congressional Budget Office estimated Aug. 11.
Put another way: Alternative ways of paying for healthcare will have 1.3+ million more potential customers amid a “perfect storm” of insurance coverage losses, Sabrina Corlette, founder and director of the Georgetown University Center on Health Insurance Reforms, told us.
These plans—like short-term health plans, farm bureau plans, fixed indemnity coverage, and nonprofit healthcare sharing ministries (HCSMs)—are exempt from Affordable Care Act protections, allowing them to charge some customers less in exchange for covering less.
Though some analysts argue these plans offer a good alternative to people who might otherwise go uninsured, the American Hospital Association says their growth could increase the billions of dollars per year hospitals and health systems spend on uncompensated care if these plans stick patients with medical bills they can’t pay.
“We’re going to see a lot more people experiencing medical debt, and the [healthcare] system is not going to be able to absorb all of that,” Molly Smith, group VP of public policy at the American Hospital Association (AHA), told us.
The hospital impact
If a patient’s non-ACA plan can’t cover their expenses and they can’t pay, it “erodes the relationship” between patients and hospitals, Ariel Levin, AHA’s director for coverage policy, told us.
(Patients’ trust in hospitals is already low, down to 40% in January 2024, according to a July 2024 JAMA Network Open article.)
Not to mention, hospitals sometimes waste time and resources going through the traditional billing process for these plans, which often fails, Levin said.
According to a May 2025 study in the journal Health Affairs Scholar, administrative expenses for 5,639 hospitals were $166 billion, or 17% of total expenses.
“This is obviously a huge problem for hospitals,” Levin added.
Is there a problem?
In theory, if a patient knows what they’re getting into with these plans and is able to foot the medical bill themselves in the case of an emergency expense, hospitals still get paid. But 8 out of 31 sales representatives for these plans engaged in “potentially deceptive” marketing, like claiming a preexisting condition was covered when it wasn’t, in a 2020 secret shopper study from independent watchdog the Government Accountability Office.
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Deceptive marketing can lead members to think they have full insurance coverage, then get shocked by hefty bills for childbirth or a colonoscopy, both of which ACA-compliant plans are required to cover.
And that marketing seems to be ramping up again.
“Purveyors of these products and arrangements will take advantage of shifts in public policy or periods of consumer confusion to market their products, often deceptively, to try to drive people to buy more,” Corlette said.
Advertising season
Insurance alternatives like healthcare sharing ministries—-arrangements defined as nonprofits, not insurance, where members with shared religious beliefs pay a fee each month to cover each others’ medical bills—are using policy changes as a marketing hook to make their case to customers.
“With new ACA restrictions taking effect, many Americans are reevaluating their healthcare options. HCSMs offer a values-based, cost-sharing alternative,” a July 9 release from self-described healthcare sharing ministry NetWell reads.
On Aug. 15, neither the release nor the main page of NetWell’s website disclosed that this arrangement isn’t insurance, though a small link at the bottom of the site led to disclaimers. After Healthcare Brew reached out for comment, the organization added a line to its main page saying it “is not an insurance company but a religious healthcare sharing ministry.”
A nondenominational crowdfunding company, CrowdHealth, made a case for the benefit of its plans in a July 21 blog post where it argues its ACA-exempt arrangement “shines for healthy families or individuals losing ACA subsidies.” CrowdHealth’s post specifies in the third paragraph that it isn’t insurance.
Netwell and CrowdHealth didn’t respond to requests for comment.
Promotional efforts will likely ramp up more when the ACA marketplace open enrollment period begins Nov. 1 and people see their premium options increase, Corlette predicted.
If enough people are swayed away from the marketplace, analysts say the growth of arrangements like short-term, limited-duration plans could alter the risk pool and drive up premiums, which are already expected to increase next year.