One of seven carriers offering Affordable Care Act Marketplace health insurance in Oklahoma will cease offering coverage next year. A health policy analyst says the move comes amid a broader trend of insurer exits as several federal policy changes fuel declining enrollment.
Mending, founded in 2021, offered individual Marketplace and small group plans in Maine and Oklahoma. Its coverage included direct primary care, a business model where patients purchase a membership for unlimited access to certain primary care services.
Normally, patients pay a monthly direct primary care fee outside of their health insurance. Mending premiums covered this payment.
Mending offered plans in 36 Oklahoma counties. Its current plans will continue through the end of the year.
But Mending’s exit from the health insurance market will ultimately impact about 7,000 Oklahomans, 85% of whom are individuals and 15% are small groups. It will also affect 1,100 Mainers.
Mending co-founder Jeff Yuan said this decision was informed by a confluence of factors, including rising healthcare costs and the expiration of enhanced premium tax credits. This change forced people to pay a larger share of — or full price for — their health coverage.
“While we have been in the market as our own insurance carrier, we are just frankly subscale,” Yuan said. “And it's harder for us to kind of grow in that type of environment.”
The company plans to continue working in the direct primary care space. This year, it launched Mending Access, a platform to help self-funded employers and third-party administrators integrate direct primary care into their plans. Self-funded coverage means an employer pays for enrollees’ medical care directly.
Yuan said Mending will also partner with CommunityCare to create Marketplace plans for next year that include in-network direct primary care doctors.
CommunityCare is Oklahoma’s largest local health plan, owned by Saint Francis Health System and Ascension St. John in Tulsa.
“The immediate partnership between us and CommunityCare is really making sure that the ACA population, the individuals and families who sign up for Healthcare.gov, who we currently insure today at Mending, have a great home for 2027,” Yuan said.
Yuan said Mending will work with CommunityCare to bring direct primary care options to members outside of the Marketplace.
He added Mending is working on a similar effort in Maine and hopes to build relationships with regional ACA carriers in other states.
Major changes, declining enrollment could lead to additional exits
Healthinsurance.org health policy analyst Louise Norris said insurer participation has fluctuated since the ACA Marketplace’s debut in 2014.
It grew initially, then declined from 2016 to 2018 as the first Trump Administration discussed repealing and replacing the ACA and cut off funding for cost-sharing reductions, which reduce out-of-pocket costs for eligible enrollees who select silver health insurance plans in the Marketplace.
“There was just a lot of upheaval and uncertainty,” Norris said. “Insurance companies don't like that. Insurance actuaries like predictability and profit.”
Participation increased or remained steady after that, Norris said. But for the first time in years, Norris said there was a decline in insurers for the 2026 plan year. Aetna had the largest market exit, impacting about 1 million enrollees in 17 states.
Norris said the 2027 plan year could see similar trends. At least seven insurers, including Mending, have announced they will no longer offer Marketplace plans after this year. This will affect more than 650,000 enrollees nationwide.
Several issues are impacting the Marketplace climate, Norris said. That includes the expiration of enhanced premium tax credits, a 2025 Marketplace rule designed to tighten enrollment requirements, and rule changes for 2027, which are expected to reduce enrollment even further.
Both rule changes are being challenged in court. Eight of the provisions in the 2025 rule were vacated June 12 by a federal judge, but Norris said she expects the U.S. Department of Health and Human Services to appeal.
In 2026, Marketplace enrollment declined nationwide after five years of growth. Nearly 50,000 fewer Oklahomans selected a Marketplace plan compared to last year, and even more are expected to drop out amid higher costs.
The overall risk pool tends to become less healthy when enrollment decreases, Norris said, which drives up the average cost per enrollee. Uncertainty surrounding federal regulations and enrollment makes it difficult for insurance companies to plan and be profitable, Norris said.
“If an insurance company can't be profitable in a given market sector, they're not really going to stay in that market sector,” Norris said.
It’s still too early to tell if this trend will continue, Norris said, as rate filings aren’t publicly available for a majority of states. She encouraged enrollees to stay updated on any notifications they receive from their plans.
Norris added people impacted by insurer exits should actively shop for a new plan that fits their needs during open enrollment, instead of letting the Marketplace automatically re-enroll them in one.
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