In Washington, “simplifying healthcare” often means “making it harder to get.” The One Big Beautiful Bill and newly published CMS (Centers for Medicare and Medicaid Services) rules do exactly that: stripping out ACA (Affordable Care Act) subsidies, tightening eligibility, and attaching Medicaid eligibility to work requirements. 

The CBO projects 16 million more people to be uninsured by 2034, a grim milestone for patients but a bullish signal for certain healthcare providers. If that sounds like gallows humor, it is. But investors must follow the policy, not the bedside manners. 

Why the ACA Slashing Matters

The new rules reward scale providers, high-deductible plans, and discount platforms ready to scoop up patients falling through the cracks. As an investor, watch the following implications:

Coverage Shrinks, Costs Climb

​​CMS’s new rules shift bargaining power toward insurers. They can now deny new exchange coverage until unpaid premiums are settled, end the “low-income” monthly special enrollment window in 2026, and impose tougher income checks and pre-enrollment verification. 

The ACA had put these and other measures in place to encourage continuous health insurance enrollment and make it harder for consumers to bounce in and out of coverage. These individuals are often young, healthy people who don’t use much care and sign up for healthcare only when they need something. By being continuously enrolled, these healthy people helped balance out the cost of covering sicker patients. 

The new CMS rules shove these young, healthy people off the exchange. And with fewer healthy members in the risk pool, which will now consist more heavily of sicker individuals who maintain continuous coverage due to ongoing health needs, insurers are increasing plan prices. 

Insurers are already reacting to the change: Aetna will exit ACA exchanges in 2026, ceding the field to remaining carriers to raise premiums. The result is simple: higher bills for consumers and more unpaid care dumped on hospitals.

Hospitals and Scale Providers Win by Default

When coverage thins out, hospitals still have to treat people who show up in the ER. Hospital giants like HCA have the balance sheets and pricing leverage to turn uncompensated care into someone else’s problem. Smaller regional hospitals, already struggling with staffing and reimbursement shortfalls, are more vulnerable.

HSAs Become the Default Cushion

As deductibles rise, consumers will lean harder on Health Savings Accounts (HSAs) to bridge the gap. HSAs are one of the rare products both political parties embrace. That makes them one of the only growth bets immune to politics.

The Finance Play in the ACA Shake-Up

Trump’s healthcare overhaul is shrinking ACA coverage, raising premiums, and pushing more Americans out of insurance coverage. Here’s the play on big hospitals, HSAs, and discount platforms standing to gain, while Medicaid-heavy insurers face mounting policy headwinds.

iShares U.S. Healthcare Providers ETF (IHF)

SPDR S&P Health Care Services ETF (XHS)

Vanguard Health Care ETF (VHT)

Global X HealthTech ETF (HEAL)

Bottom Line

The ACA retrenchment is a structural driver: fewer insured, higher costs, and more pressure on consumers. ETFs like IHF, XHS, VHT, and HEAL position you to benefit from provider pricing power, HSA growth, and digital health demand while hedging Medicaid-heavy exposure.

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November 28, 2025