The Marketplace Illusion: Coverage Without Care Shawnna Read-Richards Teresa Keller February 26, 2026

https://www.healthaffairs.org/content/forefront/marketplace-illusion-coverage-without-care The Affordable Care Act (ACA) established health insurance Marketplaces to expand coverage, improve affordability, and enhance consumer choice. However, coverage alone does not guarantee care—especially in states such as New Mexico, where plan design fails to reflect the geographic realities of care delivery. Affordability is also worsening in 2026 because the ACA’s enhanced premium tax credits, expanded during the pandemic and extended through 2025, expired on January 1, 2026, increasing net premiums for many Marketplace enrollees. As consumers face higher out-of-pocket premiums, plan design and network adequacy become even more consequential: People may be pushed into the cheapest options, regardless of whether those plans offer realistic access to in-network care.