ACA open enrollment begins Nov. 1, and health system leaders are preparing for a more unstable coverage landscape.
In late September, CMS said it had canceled plan year 2026 ACA policies for about 760,000 people. The agency also temporarily paused new agent and broker registrations until Feb. 1. HR 1 will also add work requirements, more frequent redeterminations and other paperwork burdens in 2027.
Systems are investing in enrollment support to help patients keep their coverage, launching digital tools and working with state officials and community partners. System financial leaders are also building coverage losses into their planning.
Becker’s connected with Peter Banko, president and CEO of Springfield, Mass.-based Baystate Health, and Rick Talento, CFO of Falls Church, Va.-based Inova Health System, to discuss how their systems are preparing for open enrollment and how expected coverage losses have shaped their 2027 outlook.
Question: What steps are you taking ahead of open enrollment, such as adding financial counselors, offering enrollment help or partnering with navigators?
Peter Banko, President and CEO, Baystate Health: We are proactively partnering with our health system and health plan colleagues in the Commonwealth, as well as working directly with our legislative delegation and MassHealth leadership to understand and, more important, work together to mitigate the impact of [the One Big Beautiful Bill Act]. Internally, we are introducing new digital and online tools to assist our community members to more effectively manage enrollment with all the new burdens of work requirement, more frequent redetermination, and other paperwork requirements in 2027.
Rick Talento, CFO, Inova Health System: Across inpatient, outpatient and community settings, Inova is connecting patients with clear information and qualified assistance to help them complete the necessary steps to access and maintain coverage. In a changing coverage environment, this work is critical to fulfilling our nonprofit mission. This includes investing in our existing teams that provide enrollment support for our patients as well as leveraging third-party resources that serve as force multipliers for those teams. We are also coordinating with public-sector and community partners so patients receive consistent guidance and can access help wherever they receive care and in the community.
Q: How are ACA coverage losses shaping your 2027 financial planning?
PB: As the safety net (more than 70% government payer) health system and largest health plan covering Medicare and Medicaid in Western Massachusetts, we are expecting a $147 million total annual impact from [HR 1]. The impact in FY27 just from coverage losses is budgeted to be more than $35 million. That is coupled by significant pressures (related to OB3A and our economic climate) with softer volumes, access constraints, expense inflation and diminished reimbursement. Our board and senior leadership are casting a wide net with our financial planning to accelerate existing turnaround efforts, optimize our balance sheet, explore strategic partnerships, and challenge our current thinking.
RT: Our 2027 planning reflects a more volatile coverage environment and the possibility that some patients may experience coverage gaps as eligibility, enrollment and renewal requirements change. We are evaluating a range of scenarios rather than projecting a specific financial impact at this stage. For our patients, maintaining coverage supports continuity of care, access and affordability. That is why we are making early investments in education, navigation and enrollment support.
