As of July, almost half a million New Yorkers lost coverage under the Essential Plan program
By Deborah Jeanne Sergeant
The number of health insurance plans offered by carriers in Central New York has dwindled in 2026, leaving consumers with fewer options.
George Chapman, who retired after many years operating G.W. Chapman Consulting as a hospital consultant, said that the reason health insurance companies are dropping plans is simple: “It’s always money,” he said.
“With a lot of people losing Medicaid coverage, there’s less of a risk pool. You have a lot of people without insurance which means the ones without insurance will get free care at some hospital. The fewer bodies insured, the less money they’ll make because the risk pool is smaller. That means there are not enough people to guarantee they’ll make some money.”
In mid-June, the U.S. Department of Health and Human Services state that the 13% dip in enrollment from 22.1 million in 2025 to 19.2 million in 2026 indicates fewer fraudulent enrollment. Some analysts, like Chapman, believe that the decrease in enrollment is because of the Affordable Care Act ending in February, meaning fewer people are part of subsidized health insurance plans.
“A lot of people on Medicaid who are kids subsidize the other people,” Chapman said. “Through June, 13 million did not sign up for Medicaid because they could not afford it. They lost their subsidies.”
As of July 1, almost half a million New Yorkers lost coverage under the Essential Plan, a program for people whose earnings are too high to qualify for Medicaid but still low enough to comfortably afford private insurance premiums. The new qualification maximum $31,920 for an individual or $54,640 for a family of three, which is above 200% of the federal poverty level.
In some of the worst markets, insurers dropped some of their Medicare Advantage plans, as did some commercial insurers, which leaves more leverage for the remaining insurers who do not have to negotiate as hard with hospital systems and other providers since they lack stiff competition. Chapman said this drives up the cost to consumers with plans requiring higher copays and deductibles and higher medication costs.
“I don’t know if this could be a push for national health insurance,” Chapman said. “It never seems to come up as a topic with politicians.”
He added that with no competition at all under a national health insurance system, costs could increase and he feels unsure about the risk of fraud.
Hill-HarrisX survey released in May 2026 states that only 13% of respondents favor a fully government-run health insurance program.
Chapman said that a self-insured choice for a hospital system that enrolls a lot of people may cause other commercial plans to pull out.
“I think insurance companies are sticking to the markets where they make money,” Chapman said. “Their losses exceed gains so they pull out. With the Affordable Care Act, they wanted to make sure there were at least two insurance companies per market. I’m not sure this is true anymore. I think it was tough in rural areas. It was tough to support two plans but one plan could drop out.”
In the early 2000s, concierge care was gaining traction; however, more and more physicians are currently opting to work directly for hospital systems instead of becoming completely independent as concierge providers or as insurance-accepting providers. About 75% of physicians are now employed by hospital health systems, especially those who provide specialty care.
“They’re being gobbled up by health systems,” Chapman added.
One of the reasons physicians have fled independent practice is the red tape involved with handling insurance claims and electronic medical records (EMRs). Instead of providing the amount of patient care they prefer, they find themselves buried in a laptop during visits or taking home additional work to complete EMRs so they can claim visits.
“EMRs have had a big impact on individual private practices,” Chapman said. “They were given money by Medicare, $40,000 to $50,000 per doctor to transition, and a good many said ‘forget it’ and then retired. The rest went into EMRs. They didn’t do well and wound up selling to a hospital so they could deal with it.”
Although becoming part of a large health system alleviates the headache of many administrative tasks, it also curtails autonomy and, on the patient side, limits provider choice since typically health insurance accepts only one health system. If a patient prefers a provider associated with one health system and a specialist with another, the patient must make compromises or pay more out-of-pocket for a out-of-network provider.
