Becker’s Healthcare Podcast: Key Trends in ACA Coverage and Rising Healthcare Costs

Guest: Alan Cohen, Co-Founder & Chief Product Officer, Centivo
Host: Jacob Emerson
Date: August 24, 2025

Episode Overview

This episode features Alan Cohen, Co-founder and Chief Product Officer at Centivo, discussing the unprecedented increases in health insurance premiums heading into 2026. The conversation focuses on the root causes behind soaring ACA premiums, the systemic pressures driving up costs across employer and individual markets, and the potential consequences if enhanced subsidies expire. Alan also shares Centivo’s approach to curbing costs and offers advice to industry leaders grappling with unsustainable healthcare inflation.

Guest Background ([00:16]–[03:01])

• Alan Cohen shares his extensive career in health coverage, including roles at Prudential, Cigna, Massmutual, and founding health benefits tech startups (Online Benefits, Liazon).
• Holds an MBA from Columbia and London Business School, plus an MPH from Johns Hopkins.
• Centivo, founded five years ago, partners exclusively with high-performing, clinically integrated provider organizations and ACOs, aiming to provide cost-effective, high-quality care to employers and employees.

Quote:
"One thing that always seems to be a recurring theme is healthcare inflation and trend. No matter where I go...we’re always talking about trying to bend the trend curve and simultaneously help people have access to high-quality health care that’s not...financially [harming] them or their employers." — Alan Cohen ([02:45])

Key Discussion Points & Insights

The Surge in Premiums and Healthcare Inflation ([03:01]–[14:15])

• Unprecedented ACA Premium Increases: Some states see proposed premium hikes over 50%, with the average increase at 18%.
• Premium hikes are not limited to ACA markets but also affect employer-sponsored and self-funded plans.
• Root Causes:
  1. General Health Care Inflation:
     • Drug costs, especially GLP-1s for diabetes and weight loss, are major contributors.
     • Healthcare inflation has jumped from 4-6% to 8-10%.
  2. Expiration of Enhanced Premium Tax Credits (PTCs):
     • Their possible lapse would raise out-of-pocket costs, making insurance less affordable, worsening the risk pool as healthier individuals opt out.
  3. Medicaid Coverage Reductions:
     • New budget cuts will push millions off Medicaid, increasing uncompensated care and leading providers to shift costs to commercial markets.
  4. Tariffs and Other Input Costs:
     • Rising supply costs further inflate provider expenses.
• Cumulative Effect:
  • These factors combine for the 15–20% premium increases referenced.

Quotes:
“These are shockingly high increases...We have to realize that these rises in health care costs...they just have to stop.” — Alan Cohen ([03:55])

“We have become, you know, functionally uninsured when you can’t afford your deductible and you can’t afford your out-of-pocket maximum.” — Alan Cohen ([06:29])

The Impact of Expiring Subsidies ([14:15]–[19:48])

• Consensus: Extension of enhanced ACA subsidies is highly unlikely due to prohibitive costs—$130B just this year, far surpassing CBO expectations.
• Potential ‘Death Spiral’ in ACA Markets:
  • Loss of subsidies raises effective premiums. Higher prices force healthier members to leave, worsening the risk pool and driving up premiums further.
  • “Every time you lose people, in this case you’re losing people who are on average...lower healthcare expenses, which again worsens your pool, which causes you to increase your rates again. Right. So it could get into a death spiral...” — Alan Cohen ([19:07])
• Wider Effect: Risk pool deterioration may drive an exodus from the market and continual price escalation.

Centivo’s Approach and Industry Recommendations ([19:48]–[26:44])

• Centivo Model:
  • Prioritizes high-performing, cost-effective provider networks (e.g., Mount Sinai, Orlando Health).
  • Mandates members align with advanced primary care teams to orchestrate care and manage overall population health.
  • Uses value-based contracting over fee-for-service to reward improved outcomes and lower costs.
  • Demonstrable results: improved control of chronic conditions, early detection, and lower cost inflation for clients.

Quote:
“What we do at Centivo is...plans that will increase at a significantly lower rate...because we work with providers who themselves are high performing.” — Alan Cohen ([20:54])

• Advice for Health Plan Leaders and Providers:
  • Providers should partner with plans dedicated to aligning incentives for value and population health.
  • Employers should demand viable, long-term strategies ensuring affordable, high-quality care.
  • Urges collective industry action: “We cannot accept the status quo because the status quo has taken us right off a cliff.” ([26:44])

Notable Quotes & Memorable Moments

• On Deductibles: “We don’t have that escape valve anymore because deductibles are as high as they can be...people have $2,000, $3,000, $5,000, $6,000 deductibles, $10,000, $15,000 out of pocket maximums.” — Alan Cohen ([06:42])
• On Subsidies and Market Stability: “We could see the ACA market get into, you know, a real death spiral...” — Alan Cohen ([16:16])
• On the Need to Change: “If we are unhappy with...the cost of health care and...the unequal delivery... we need to look at ourselves in the mirror. We’re the ones in the industry and we’re the ones who created this. And so we’re the ones who need to change it.” — Alan Cohen ([25:51])

Important Timestamps

• [00:16] — Alan Cohen’s background and Centivo’s mission
• [03:01] — Premium increase trends and industry challenges
• [07:32] — Breakdown of drivers behind rising costs
• [14:15] — Outlook on extending enhanced subsidies
• [16:16] — Risk of ACA market ‘death spiral’
• [19:48] — Centivo’s differentiated approach
• [25:39] — Final advice for health plan leaders

Tone and Takeaways

Candid, passionate, and urgent, Alan Cohen calls for the healthcare industry to confront rising costs head-on. He stresses the need for structural innovation—moving away from short-term fixes (like raising deductibles) and embracing value-based, partnership-driven models that realign incentives for quality and affordability. Leaders are urged to reject the status quo and drive change before “the system breaks.”