In this special Halloween edition of the Cutting Edge Benefits Podcast, Tom Quigley and Neil Haley dissect breaking news from the healthcare industry: CVS Health’s shocking decision to exit the ACA individual marketplace in 17 states for 2026. While some may see this as an isolated corporate move, Tom argues it’s a clear reflection of a profit-obsessed system collapsing under its own weight.
With his trademark candor, Tom calls out the real motives behind CVS’s exit—profit margins and shareholder demands—not consumer care or innovation. He breaks down how the ACA individual market became an unprofitable “loss leader” for major corporations, likening CVS’s health plans to the cheap gas at a convenience store—a hook to get people in the door to buy other stuff.
Throughout the conversation, Tom and Neil use sharp analogies, humor, and blunt truth to expose the dysfunction in the current system and guide business owners on how to protect their teams from market chaos in 2026 and beyond.
Why CVS Really Exited the ACA Market
CVS Health, through Aetna, wasn’t earning enough profit to satisfy shareholders.
Tom: “They’re stock companies. If they’re not making enough for their shareholders, they’re gone—goodbye, see you next.”
Their ACA product featured limited networks and underperforming teams—“probably former failed insurance agents,” Tom jokes.
The Corporate Game: It’s All About the Store Traffic
CVS’s goal wasn’t to revolutionize health insurance—it was to get more people into the store.
Tom compares their strategy to gas stations offering cheap gas to sell snacks and drinks.
“Drugs were their loss leader,” Tom says. “They wanted you to come in for prescriptions, then leave with almonds, ice cream, and a passport photo.”
Impact on Employees and Consumers
Those with CVS/Aetna ACA plans will have to switch to other carriers in their state.
Some states, like Kentucky, have only two carriers left, making this exit more significant.
Still, Tom emphasizes: “It’s just one more carrier playing the profit game—it’s not about care, it’s about stock price.”
Deeper Instability or Business as Usual?
CVS’s move doesn’t signal a total collapse but highlights systemic instability where insurers chase higher-profit markets.
“They might make 10% profit, but they want 20%. It’s never enough,” Tom explains.
How Small Businesses Can Protect Their Teams
Tom urges business owners to change their mindset: buy catastrophic insurance only, then fund the rest of the benefits directly.
“Stop chasing headlines. You’re not buying insurance—you’re building benefits,” he says.
ClaimLinx’s approach helps businesses control their own benefits, avoiding disruptions caused by insurer shifts or government subsidies.
Lessons from the Corporate Health Shuffle
Large insurers view health coverage like CVS views snacks—it’s about upselling.
Insurance companies want you to add dental, vision, and extras that bring pure profit.
“They want impulse buyers,” Tom says. “If everyone only bought what they needed, the whole agent system would collapse.”
The November Crunch: Renewals and Subsidy Changes
With subsidies set to sunset, fearmongering headlines will explode—but Tom insists it’s just political theater.
“They’ll adjust the premiums, move a few numbers, and make it sound like the world’s ending,” he quips.
His advice? “Ignore the noise. Focus on your business’s balance sheet.”
“If you’re smart, you buy catastrophic insurance and fund benefits yourself. Everyone else is just impulse-buying health care.” — Tom Quigley
“It’s all buzzwords and headlines—CNN, MSNBC, they love scaring people. I love saving them instead.” — Tom Quigley
👉 Website: www.ClaimLinx.com
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Stay ahead of healthcare disruption with the Cutting Edge Benefits Podcast, where Tom Quigley and Neil Haley deliver straight talk on how to beat the system, save money, and empower your employees.