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Obamacare Crushed Choice. This Reform Helps Restore It
Sally Pipes, · 2026-04-20 · via Forbes - Policy
President Obama

"Multi-year plans wouldn’t just make coverage more stable. They could make it smarter—aligning incentives around long-term health," says health expert Sally Pipes. "Perhaps most importantly, these reforms would reintroduce something Obamacare largely eliminated: choice."

Getty Images

Every fall, millions of Americans log onto the Affordable Care Act’s exchanges hoping to find a health plan that fits their needs. This year, roughly 23 million people have signed up through the marketplaces.

Many are discovering that their options all look more or less the same—expensive and ill-suited to how they use care.

That’s no accident. Obamacare standardized health insurance into a one-size-fits-all product and left little room for innovation.

Now, the Trump administration is signaling a long-overdue shift. A new rule from the Centers for Medicare and Medicaid Services would loosen restrictions on catastrophic health plans and pave the way for multi-year policies that could last up to a decade.

That’s a welcome change—one that could make coverage more affordable and more useful.

Catastrophic plans are designed to do what insurance does in nearly every other market—protect against worst-case scenarios. They come with lower premiums and higher deductibles, cover major medical events and leave routine expenses to patients.

For many Americans, especially younger and healthier ones, that’s exactly the kind of coverage they want.

Yet under Obamacare, these plans have largely been off-limits. Until this year, only people under 30 or those who qualified for a hardship exemption could enroll. Everyone else was steered into more comprehensive—and more expensive—coverage, whether they needed it or not.

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Now, anyone ineligible for federal premium or cost-sharing reduction subsidies can claim that exemption and purchase a catastrophic plan.

Critics dismiss catastrophic plans as “junk coverage.” But in virtually every other market—auto, home, even life—this is what insurance looks like. We don’t expect car insurance to cover oil changes. We expect it to protect us in a crash.

Health insurance used to work the same way. Over time, it has morphed into something closer to prepaid medical care.

The new CMS proposal would begin to reverse that trend. By expanding access to catastrophic coverage and encouraging longer-term plans, it would give consumers more control.

The move toward multi-year plans is especially promising.

Under the status quo, most Americans must shop for coverage every year—often with little certainty about premiums, plan availability or benefits. Fewer than one in five people remain with the same insurer over a five-year period, according to research from the Paragon Health Institute.

That churn makes it harder for consumers to plan—and harder for insurers to design better products.

Multi-year plans could change that.

By allowing individuals to lock in coverage for several years at a time, these policies would offer something rare in today’s market: predictability. Enrollees could protect themselves from sudden premium spikes and avoid the annual disruptions that come with switching plans.

That stability would open the door to real innovation.

Consider a patient with diabetes. Today, that person may switch plans every year—bouncing between formularies, provider networks and care programs. Insurers have little incentive to invest in long-term disease management if the patient may be gone in 12 months.

A multi-year plan changes that calculus. If an insurer knows it will cover a patient for several years, it has a strong incentive to keep that person healthy—by investing in prevention, medication adherence and better chronic disease management. Avoiding complications isn’t just good medicine; it’s good business.

Longer-term coverage would also make benefits more predictable and patient-friendly.

Instead of forcing patients to restart their deductible every January, a multi-year plan could spread cost-sharing over time. Patients who face a major medical event wouldn’t be forced to start from scratch the following year, and insurers could design coverage that is more stable and transparent.

In short, multi-year plans wouldn’t just make coverage more stable. They could make it smarter—aligning incentives around long-term health, not short-term accounting.

Perhaps most importantly, these reforms would reintroduce something Obamacare largely eliminated: choice.

A significant share of uninsured Americans don’t lack coverage simply because of cost. According to research from the Centers for Disease Control and Prevention, many say they don’t want or need the plans available—or that those plans don’t meet their needs.

That’s what happens when a market offers what is effectively the same product to everyone, regardless of age, health status or personal preference.

Americans don’t just need cheaper insurance. They need better options. Expanding access to catastrophic plans—and allowing them to evolve into long-term, flexible coverage—would be a major step in that direction.

After years of rigid rules and rising costs, it’s time for Washington to let the health insurance market breathe again.