Insurer Profits Rise as Cigna Fires its ACA Customers, Healthcare CEOs Choose Self-Preservation Over Systemic Repair, and US Interoperability Remains a Legal Myth

Hey all, 

Happy Tuesday! Welcome to the pre-collapse party where the canary in the coal mine didn't just stop singing—he expired quietly because he couldn’t afford the out-of-network deductible for the ER visit. Cigna’s decision to dump nearly 400,000 paying ACA members is the ultimate harbinger of 2036, signaling a future where insurers only "innovate" when the federal government is footing the bill and the exits are paved with shareholder gold. As we march toward a total systemic meltdown, our leaders remain committed to "radical incrementalism," rather than admitting that rearranging deck chairs won't save a ship that’s already missing its engine.

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

[HEALTH CARE un-covered] Cigna Reports Q1 2026 Gains and ACA Marketplace Exit

Cigna reported a 12% increase in adjusted operating income for Q1 2026 and raised its full-year profit guidance, signaling a strong financial performance for shareholders despite missing some analyst estimates. Alongside these gains, the insurer announced it will exit the ACA Marketplace after the 2026 plan year, a move that will displace 369,000 members across 11 states as the company pivots away from low-scale segments. It turns out that corporate "innovation" and market participation are strictly contingent on the government picking up the tab, as insurers like Cigna seem to lose all interest in the ACA the second they have to actually collect premiums from consumers instead of a guaranteed federal pipeline.

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[The Keckley Report] Incrementalism vs. Transformation in US Healthcare

U.S. healthcare leaders are currently prioritizing "radical incrementalism" and organizational self-preservation over meaningful systemic transformation in response to converging economic pressures and political volatility. This defensive strategy focuses on cost-cutting and horizontal consolidation to ensure short-term survival while largely ignoring the structural instability that threatens the industry’s long-term viability. Since the industry seems to believe that slow-walking toward a cliff is the same thing as a scenic hike, we can all rest easy knowing the system is scheduled for a total collapse by 2036—just in time for us to wonder why "changing the oil" didn't fix a "missing engine" problem.

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[Brendan Keeler] The Interoperability Doctrine

The European Union is advancing an "interoperability doctrine" that forces dominant platforms to open up based on consumer "attractiveness" rather than absolute necessity, signaling a major shift in digital competition law. Conversely, the United States remains shackled to the 2004 Trinko precedent, which effectively treats a "duty to deal" as a legal myth and forces health IT interoperability to hide inside the Trojan horse of specific bureaucratic mandates like the Cures Act. It is truly heartening to see the U.S. ignore the broad stroke of antitrust reform in favor of its preferred hobby: building a Rube Goldberg machine of hyper-specific regulations that attempt to fix with a thousand Band-Aids what one clear competition law could actually solve.

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