With just 21 days left on the clock, Tom Quigley dives headfirst into the reality many Americans are now waking up to: enhanced ACA subsidies are gone, the income cliff is back, and 2026 is shaping up to be a brutal year for anyone relying on the Affordable Care Act.

In this raw, unscripted conversation, Tom and Neil break down what’s actually happening (and what isn’t), why people are shocked by 300–400% premium increases, and why millions of Americans are suddenly forced to choose between overpriced insurance or rolling the dice uninsured.

Tom doesn’t sugarcoat it. This episode is about risk, reality, and consequences—and why the government’s failure to act now will ripple through the economy, healthcare system, and middle class in 2026.

Tom clarifies the biggest misunderstanding:

• Subsidies were not eliminated

• Enhanced subsidies were

• The old income cliff is back

Example:

• Household threshold: $81,000

• Income at $81,000.01
  👉 Entire subsidy must be repaid

Tom:

“There are no layers anymore. It’s a cliff.”

This puts enormous pressure on:

• Self-employed individuals

• Commission-based earners

• Families with bonuses or fluctuating income

Tom shares a real client story:

• Couple paying ~$670/month

• New premium: $2,800/month

The options?

• Keep income artificially under the threshold

• Pay nearly $34,000 a year for coverage

• Or… go uninsured and gamble

One client’s decision:

“I’ll take my chances at 64. I’ll gamble for a year.”

Tom makes it clear:

• Insurance exists to transfer risk

• Without catastrophic coverage:

  • Bankruptcy

  • Lifetime payment plans

  • Financial ruin

While virtual care and third-party services can help, they are not a replacement for catastrophic protection.

Tom:

“Being uninsured is a quick way to go bankrupt.”

Tom reiterates his long-standing position:

• Buy catastrophic coverage

• Use:

  • HSAs

  • Medical Expense Reimbursement Plans

• Pay out-of-pocket tax-free

• Stop paying for “kitchen sink” coverage you don’t need

The problem?
Most people have never been educated on how insurance actually works.

Neil asks the big question: How much damage does this do in 2026?

Tom’s answer:

• It absolutely hurts the economy

• Healthcare inflation eats disposable income

• Middle-class spending slows

• Hospitals take on unpaid care

• Employers face more pressure

Tom:

“They need to extend the subsidies for two years and actually fix the system.”

Tom tears apart proposals to simply fund HSAs or give people cash:

• People already don’t understand deductibles

• They won’t spend it on healthcare

• They’ll spend it on:

  • Christmas

  • Cars

  • Living expenses

Tom:

“Trusting people with money for something they’ve never been educated on is laughable.”

Tom makes an important distinction:

What the ACA got right:

• No pre-existing condition exclusions

• No lifetime limits

What broke the system:

• Forced coverage of all 10 essential benefits

• No ability to carve out unnecessary coverage

• Exploding premiums due to overregulation

Tom:

“Why is a 57-year-old man paying for maternity coverage?”

Tom pulls no punches:

• Group health agents are commission-driven

• They actively fight solutions that reduce premiums

• National insurance associations lobby to protect commissions

• Employers listen to them—and lose millions

Example:

“A company in St. Louis is throwing away a million dollars because their agent told them our solution was wrong.”

Tom predicts:

• Democrats benefit politically if subsidies expire

• Upper-middle-class voters feel the pain first

• Republicans in tight races are exposed

• Another government shutdown is likely in January

But by then?

“The train has already left the station.”

There is no healthcare crisis.

There is:

• An education crisis

• A lobbying crisis

• A political courage crisis

Tom:

“I’ve been saying for 25 years the system doesn’t work. Now people are finally listening.”

• Enhanced subsidies are gone — the income cliff is real

• Premium shocks of 300–400% are happening now

• Going uninsured is a dangerous but increasingly common choice

In this episode, Tom Quigley of ClaimLinx delivers a wake-up call to employers still buying health insurance with outdated strategies. If your company is stuck in the 1990s mindset—high premiums, minimal customization, and cookie-cutter plans—then you're bleeding cash. Tom explains how modern 2026 health plan design leverages Section 105 tax law, medical expense reimbursement plans (MERPs), and a fully customized approach to cut costs while improving employee benefits.

He breaks down what today’s smartest employers are doing instead—and why relying on commission-based brokers is one of the costliest mistakes businesses continue to make.

• 🧠 Most businesses still buy health insurance like it’s 1998—despite decades of regulatory and technology shifts.

• 📉 You can save 30–60% by buying the lowest-cost group option and using MERPs to fill in the gaps.

• 🤯 Brokers are incentivized to keep your premiums high because they earn a percentage of what you pay.

• 🧾 Section 105 allows you to self-fund benefits tax-free and offer better plans to employees without overpaying insurers.

• 🔥 Employers should stop handing off benefits decisions to HR—this is a finance-level strategic decision that affects EBITDA.

• 🕒 There’s still time to implement smarter 2026 benefits before December 31st, but most companies wait too long.

“We’re not solving world peace—we’re solving a health insurance crisis that doesn’t actually exist. You’re just being ripped off.”
— Tom Quigley

“If you're working harder and making less, it’s because your business is paying 1998 prices in a 2026 market.”
— Tom Quigley

• Small and mid-sized business owners

• CFOs and controllers

• HR directors ready to rethink open enrollment

• Entrepreneurs tired of skyrocketing healthcare costs

• Self-employed individuals shopping for better options

Visit ClaimLinx.com to schedule a strategy call with Tom and his team.

Spotify | Apple Podcasts | Google Podcasts | Amazon | iHeartRadio

💥 Key Takeaways:💡 Notable Quotes:👥 Who This Episode Is For:📞 Ready to Modernize Your Health Plan?🎧 Available On:

In this urgent episode, Tom Quigley of ClaimLinx breaks down the confusion and panic surrounding the sunsetting of enhanced ACA subsidies at the end of 2025. Many individuals and small business owners are seeing massive spikes in healthcare premiums—but much of the fear is based on misinformation.

Tom clarifies what’s actually happening, who’s impacted, and why the enhanced subsidies were so critical for middle and upper-middle-class Americans. He also dives into the politics behind the delay in action, and how smarter plan design using Section 105 and Medical Expense Reimbursement Plans (MERPs) can offer financial relief—even if the subsidies expire.

• ✅ Enhanced ACA subsidies were introduced during COVID and extended via the Inflation Reduction Act through 2025.

• ❗ They’re set to expire on December 31, 2025, unless Congress intervenes.

• 🔍 The sunset of these subsidies mostly affects the middle and upper-middle class, not lower-income earners.

• 💰 Families could see their premiums jump from $200 to over $1,800–$5,500 per month in some states like New York.

• 🔧 Traditional brokers are pushing ICHRAs (Individual Coverage HRAs), but Tom explains why MERPs are more flexible, tax-advantaged, and cost-effective.

• 📉 Insurance brokers and carriers don’t want consumers to understand how this system works—because it threatens their commissions.

• ⚠️ The threat of a government shutdown in January 2026 looms if Congress fails to act.

“People are paying more for health insurance than their mortgage—and they’re being told that’s normal.” – Tom Quigley

“The insurance industry thrives on your confusion. The more you don’t know, the more they make.” – Tom Quigley

• Small business owners struggling with rising healthcare premiums

• Self-employed professionals facing premium shock

• HR teams and CFOs evaluating 2026 benefit plans

• Anyone confused about ACA subsidies and what's next

Visit ClaimLinx.com
Schedule a strategy call with Tom and his team to find out how to lower costs, even without subsidies.

Spotify | Apple Podcasts | Google Podcasts | Amazon | iHeartRadio

💥 Key Takeaways:📢 Notable Quotes:👥 Who Should Listen:📞 Take Action:🎧 Listen On:

Health insurance costs are rising fast—and small businesses are feeling the heat. In this episode, Tom Quigley explains how smarter plan design can slash health insurance costs by 30–60% while improving employee benefits.

Tom outlines why traditional insurance plans are loaded with unnecessary costs, how pharmaceutical rebates are being hidden, and why most employers are unknowingly overpaying by tens of thousands each year.

The truth? You're paying for features your employees barely use—and getting crushed by deductibles and rate hikes in return.

• Why traditional insurance carriers overcharge for basic coverage like copays and office visits

• How to restructure your plan using a high-deductible option + a Medical Expense Reimbursement Plan (MERP)

• What hidden cost drivers (like PBM rebates) are doing to your premiums

• Why “lowering costs” by raising deductibles hurts your employees

• The real math behind how ClaimLinx saves companies thousands per employee

• Simple first steps every small business owner can take today to stop the bleeding

Tom shares how companies using the ClaimLinx method have saved tens of thousands—even hundreds of thousands—per year by simply purchasing their insurance differently.

“You think you're lucky with a 6% rate hike? Try raising your prices 6% and see how your customers react.” – Tom Quigley

Visit ClaimLinx.com
Schedule a free consultation with Tom and his team today.

Spotify | Apple Podcasts | Amazon Music | iHeartRadio | Google Podcasts

💡 Key Topics Covered:🔧 Real-World Results:🧠 Smart Quote:📞 Want to Save 30–60% on Health Insurance?🎧 Available On:

In this powerful episode, Tom Quigley breaks down the real role of a benefits consultant—and why small businesses can’t afford to rely on traditional health insurance brokers anymore.

Tom outlines how most brokers are incentivized by insurance carriers, not employers, and how this creates a massive blind spot for business owners trying to contain healthcare costs. He explains the difference between selling a product and building a cost-saving strategy.

If your premiums keep rising and your employees keep getting hit with higher deductibles and less coverage, it’s time to rethink who’s advising you.

• What a true benefits consultant does (hint: not just pushing a spreadsheet)

• The conflict of interest in traditional broker models

• How ClaimLinx finds grants, rebates, and hidden savings for employees with major medical conditions

• Why your business is likely bleeding money on health insurance without realizing it

• Examples of businesses saving 30–60% annually using smarter plan designs

• The power of a Medical Expense Reimbursement Plan (MERP) for covering gaps cost-effectively

• Why owner involvement is critical—and why relying on HR alone is a mistake

“Convincing people they’re being ripped off is easy. Convincing them to change? That’s the hard part.” – Tom Quigley

Visit ClaimLinx.com
Schedule a call with Tom and his team today.

Spotify | Apple Podcasts | Google Podcasts | Amazon Music | iHeartRadio

💡 Key Topics Covered:🔥 Quote of the Episode:📞 Ready to Cut Costs?👂 Listen Now On:

In this packed episode, Tom Quigley invites Amber Krauza of CEHAS to help tackle one of the biggest questions hanging over the country right now: “What the hell are people supposed to do when health insurance jumps 40%, 50%, even 60% overnight?”

The entire marketplace is in upheaval — open enrollment is a disaster, premiums are skyrocketing, networks are shrinking, and millions of people suddenly can’t afford coverage. Tom and Amber break down real alternatives for both individuals and employers, especially people who are healthy, priced out of the ACA marketplace, and sick of fighting with insurance companies and corrupt state departments of insurance.

Amber brings solutions for 40 out of 50 states, while Tom exposes why the system is collapsing — and why employers absolutely must pivot or face financial ruin in 2026.

This episode blends hard truth, practical solutions, and Tom’s classic “tell it straight” commentary — plus a few jokes about monkeys, Chicago, Wheaton, and why no one under 30 wants to leave their house anymore.

• ACA premiums in many areas have risen 40–60%.

• In some states, networks have collapsed to the point where there’s only one hospital available.

• Brokers who ignored Amber 6 months ago are now calling her back begging for solutions.

Amber breaks down three types of plans for individuals and employer groups:

• Available in 40 states

• Nationwide access

• 5–6 strong network choices including:

  • Blue Cross Blue Shield

  • Aetna

  • Cigna

  • FirstHealth/PHCS

  • HealthSmart

• Rates barely moved this year — one plan increased only 3.5%, compared to the marketplace’s 40–50%.

• Similar to “major medical lite”

• Lower premiums

• For employers who still want solid coverage but cannot afford traditional plans.

• Designed to avoid employer mandate penalties

• A workable option for:

  • Restaurants

  • Hospitality

  • Retail

  • High-turnover industries

• Ensures employees have basic coverage to keep them compliant.

• For healthy people willing to roll the dice

• 10 doctor visits per year

• $1M annual / $5M lifetime max

• Telemedicine included

• Great for:

  • Gap months

  • New hires

  • People waiting for Medicare

  • People priced out of ACA

Amber explains pre-existing condition rules:

• Only major conditions in the last 5 years trigger a decline.

• Type 2 diabetes? Accepted.

• High blood pressure? Accepted.

• CPAP use? Accepted.

• Pregnant? Still accepted if enrolled before diagnosis.

• No SSN required — ITIN / Tax ID is fine.

Huge advantage: “Applications submitted by the 18th start the 1st of the next month.”
You don’t have to wait for open enrollment.

Tom explains why business owners can’t ignore this:

• Staying with traditional insurance could bankrupt them.

• MEC or MVP plans can save businesses, especially in industries with:

  • Small margins

  • High employee turnover

  • Low subsidy qualification

• These plans allow employers to offer something instead of nothing, helping retention.

• Brokers told clients “Don’t worry, I’ll get you a great deal” — now they’re eating their words.

• Many are calling Amber for help because their networks disappeared or premiums doubled.

• Tom:

  “I could train a chimp to do what most brokers do. Press a few keys, print a spreadsheet, and call it a day.”

Amber and Tom both warn:

• If people can’t afford insurance, hospitals will get crushed.

• Marketplace access is shrinking.

• Many states with corrupt insurance departments block competition altogether.

• Solutions must come from outside the traditional industry.

Amber highlights a fascinating shift:

• Younger people (20s & early 30s) avoid doctors, offices, or anything requiring in-person visits.

• They love:

  • Telemedicine

  • Links

  • Online enrollment

  • Zero paperwork

Meanwhile older generations still want paper forms and face-to-face meetings.

• If you’re healthy but can’t afford ACA premiums:
  Amber’s plans are a strong alternative.

• If you’re an employer getting crushed by 2026 renewals:
  Consider MVP or MEC options to keep your business afloat.

• If you’re between jobs or waiting for Medicare:
  Limited medical plans can provide safe temporary coverage.

• 
  

In this direct, no-filter conversation, Tom Quigley tackles the question dominating American households, employers, and policymakers right now:

Will the enhanced ACA subsidies sunset — or will politicians cave and extend them?

Tom breaks down the math, the politics, the corruption, and the sheer incompetence swirling in Washington as lawmakers try to figure out what the hell to do with a healthcare system on the brink of collapse. He doesn’t hold back, calling out both parties, the lobbyists, the insurance companies, and the total lack of understanding lawmakers have about how insurance actually works.

This episode is Tom at full force: blunt, sharp, and brutally honest — dropping insight after insight on how subsidies interact with employer insurance, why the math is being ignored, and how the entire debate is based on false assumptions about what consumers understand (spoiler: they don’t).

• Politically, Democrats want subsidies extended.

• Some Republicans can’t afford to vote against them or they risk losing tight races.

• Tom predicts:

  • Maybe a one-year extension

  • Maybe another compromise

  • Definitely more confusion

• The real issue: Both parties are missing the mathematical reality.

Tom explains the hidden truth:

• A 25-person group paying $500,000 annually in premiums → NOT taxable

• If 20 employees move to subsidies and only 5 remain on the plan → employer pays $100,000

• The remaining $400,000 becomes taxable income

• That taxable income more than offsets the cost of extending subsidies

Yet politicians never include this in their budget debates.

Tom:

“They have NO clue what they’re talking about when they go on TV. Not one.”

• Middle-class families get crushed — especially two-income households.

• One $2,000 raise could push a family over the subsidy threshold → they owe the full subsidy back.

• Without subsidies, millions can’t afford premiums and hospitals get slammed with unpaid care.

• Politically, Republicans know this could cost them elections.

Tom’s take:

“If I’m the Democratic candidate, I’m hiring someone like me to explain exactly how the Republicans are screwing people.”

• There’s talk of giving people subsidy money directly.

• Tom laughs:

  “They’ll use the money for Thanksgiving or Christmas — not deductibles.”

• Neil adds:

  “Or put it down on a car.”

• Tom says the only way cash transfers could work is with a locked medical card and someone advising them — otherwise it’s a disaster waiting to happen.

Tom outlines a reality no politician will touch:

• The ACA would’ve been fine if networks were left alone.

• The 10 essential benefits requirement blew up premiums.

• Insurance companies and hospitals have been fleecing America ever since.

• Lobbyists have blocked nearly every reform that could lower costs.

• Tom’s national fix would solve everything overnight:

  • $50,000 deductible on every American

  • Government reinsures everything above it

  • Employers allowed to self-fund below that amount

  • No employer mandate

  • Real competition underneath

Tom:

“But they don’t want solutions. They get elected by scaring everyone.”

Tom doesn’t hold back:

“Nancy Pelosi was 85 years old. What is she still doing in Congress?”

“Our forefathers wanted one or two terms and you're out — now you need a billion dollars to run.”

• Businesses must prepare now — subsidies may or may not be extended, and chaos is guaranteed.

• ClaimLinx can reduce exposure, lower costs, and help employers navigate either outcome.

• Move employees to subsidies when appropriate — the taxable income created offsets tax burdens.

• Stop trusting politicians — trust the math.

• Have a 2026 strategy ready before the government announces anything.

“They don’t understand deductibles, co-insurance, or copays — and you want to hand them $6,000 and expect them to be wise consumers?” — Tom Quigley

“This isn’t health insurance. It’s a tax break with rules. Learn the rules.” — Tom Quigley

“Insurance companies, hospitals, pharmaceuticals — they’re all fleecing America.” — Tom Quigley

👉 Website: www.ClaimLinx.com

After breaking news about skyrocketing 2026 health insurance premiums, this follow-up episode dives into the solution—how ClaimLinx simplifies the chaos of employee healthcare for small and mid-sized businesses.

Host Tom Quigley pulls back the curtain on an industry designed to confuse, where most employers think “the more you pay, the better the plan.” In reality, the opposite is true. Tom explains that health benefits are a math problem—and ClaimLinx knows how to solve it every time.

By combining transparency, logic, and math-based planning, ClaimLinx helps business owners move from frustration and confusion to complete clarity—saving hundreds of thousands in premiums while giving employees better coverage.

1. Why Employee Healthcare Is So Confusing

   • The insurance industry thrives on complexity—deductibles, copays, and coinsurance are intentionally designed to confuse.

   • “You’ve got a $3,000 deductible, but the hospital bills you $6,000. No one understands why,” Tom says.

   • Agents and carriers benefit from the confusion—it keeps employers dependent on them.

2. The Biggest Misconception in Benefits

   • Most companies believe higher premiums mean better coverage.

   • Tom flips that on its head: “The less you pay, the better the benefits—because you can do it smarter yourself.”

   • By restructuring plans and leveraging tax law, ClaimLinx regularly reduces premiums by 40–70%.

3. The ClaimLinx Approach: Simple Math, Proven Results

   • “We’re under the premise that two plus two really does equal four,” Tom says.

   • ClaimLinx treats benefits as a math equation, not a guessing game.

   • Example: converting a $5,000 deductible plan into a zero-deductible, copay-based plan that saves employers money and boosts employee satisfaction.

   • “If you write down the numbers, I win every time,” Tom jokes.

4. How ClaimLinx Consulting Simplifies Everything

   • The process is straightforward: analyze, restructure, and educate.

   • ClaimLinx handles all plan setup and ongoing support, while showing employers exactly how and whythey’re saving money.

   • Every client receives access to a claims portal and is paired with a dedicated service rep and licensed agent for year-round support.

   • “If they use us as their advocate, they’ll be very happy,” Tom explains.

5. Proven Success in Action

   • On the day of recording, Tom reports four new companies signing with ClaimLinx—representing over $1.8 million in savings.

   • Clients find him through TV appearances, email outreach, and referrals.

   • “They’re starting to realize I’m not just talking about saving money—I’m proving it,” Tom says.

6. Media and Awareness

   • Neil points out that Tom’s expertise deserves a national stage: “You should be on Fox, CNN, MSNBC—everywhere.”

   • Tom laughs it off: “They don’t want answers. They want everyone mad at everyone.”

   • Neil adds: “Then we’ll take it to Newsmax—my media giant’s got you covered.”

• Stop overpaying for confusion. Simpler plans = smarter savings.

• Rethink “value.” Premium cost does not equal quality of care.

• Treat benefits like a math problem. With the right formula, your company can win every time.

• Leverage expert advocacy. Let ClaimLinx handle the complexity so you can focus on running your business.

“The more you pay, the worse your benefits are. The less you pay, the better they get—if you do it right.” — Tom Quigley

“We’re under the premise that two plus two really does equal four. It’s math, not magic.” — Tom Quigley

“If you write down the numbers, I win every time. I never lose.” — Tom Quigley

“Confusion is profitable for them. Clarity is profitable for you.” — Tom Quigley

“They don’t want answers—they want outrage. I want solutions.” — Tom Quigley

👉 Website: www.ClaimLinx.com
📞 Schedule a Call: Talk to Tom Quigley and his team today to simplify your company’s health benefits and start saving immediately.

The Cutting Edge Benefits Podcast delivers straight talk, real math, and zero fluff about fixing America’s broken employee benefits system.
Simulcast weekly on The Neil Haley Show, reaching over 150 stations and 5 million listeners nationwide.

In this explosive Cutting Edge Benefits Podcast episode, Tom Quigley delivers his most powerful reality check yet on the 2026 healthcare crisis. With UnitedHealthcare and other major carriers raising premiums by 40–52%, Tom exposes how employers are being ripped off in broad daylight—and how ClaimLinx’s simple, proven system could slash costs by hundreds of thousands of dollars.

Tom reveals an actual client example: their premiums skyrocketed from $62,000 to $95,000, yet with ClaimLinx, those same benefits could cost just $25,000—a savings of over $800,000. He calls out insurance companies, agents, and Congress alike for being part of a corrupt, profit-driven machine that’s pushing small businesses and the middle class to the brink.

This episode is classic Tom: unfiltered, data-driven, and fiercely protective of the American business owner.

1. The Breaking News: Out-of-Control Premium Increases

   • A real business example shows a 52% rate hike from UnitedHealthcare.

   • ClaimLinx’s solution would cut those costs by nearly 75%.

   • Tom: “Help me help you. I’ll save you $800,000—but you have to listen.”

2. Why Premiums Are Exploding

   • The sunset of government subsidies opened the floodgates for carriers to gouge businesses.

   • “These companies—United, Aetna, all of them—they’re stock companies. Their job is to increase stock value, not protect you.”

3. The Math No One Talks About

   • Tom breaks down the numbers:

     • Middle plan: $180,000 premium reduction potential.

     • Out-of-pocket lowered for employees.

     • Employer net savings: $150,000–$250,000 on a 25-person team.

   • “It’s math, not emotion. The agents don’t even understand the spreadsheets they’re selling.”

4. How the Current System Hurts Employees

   • HR departments are cornered, employees pay more for less, and agents collect bigger commissions.

   • “Everyone wins but you: agents get a raise, carriers please their shareholders, and states collect premium taxes.”

5. The ICHRA Illusion vs. the ClaimLinx Solution

   • Tom exposes individual coverage HRAs (ICHRAs) as a costly trap.

   • “Premiums and out-of-pocket hit $10,500—what a joke.
     A Medical Expense Reimbursement Plan does it all better and cheaper.”

6. How to Survive the 2026 Crisis

   • Rethink insurance: buy catastrophic coverage only and self-fund benefits through tax-advantaged plans.

   • “Pay for direct primary care—$99/month, unlimited visits, cheaper labs—and save the rest for real emergencies.”

   • Stop giving away $50,000 a year to insurance companies. “Invest it in your people or your business.”

7. Tom’s Message to Congress

   • “They’re all corrupt. They live in la-la land.”

   • He proposes a national fix:

     • A $50,000 deductible for every American, funded by tax-free savings and competitive markets underneath.

     • “Let the free market and logic win—this system is designed for failure.”

8. The Middle Class Is Getting Crushed

   • Wages can’t keep up with inflation and healthcare inflation.

   • “They’re paying $4,600 a month for health insurance—that’s their mortgage, their car, and their cottage combined!”

   • Tom warns that small business owners who accept these hikes are dooming their future.

• Stop buying insurance the traditional way. You’re financing corporate greed.

• Switch to a Medical Expense Reimbursement model. It’s flexible, legal, and proven to save 50% or more.

• Use Direct Primary Care to eliminate waste and give employees real healthcare access.

• Contact ClaimLinx now before your 2026 renewals hit—every day you wait, you lose money.

“They’re stock companies. Their job is to make shareholders richer—not to protect you.” — Tom Quigley

“Help me help you. I’ll save you $800,000 if you just listen.” — Tom Quigley

“It’s math, not emotion. The agents can’t even read their own spreadsheets.” — Tom Quigley

“They all win—insurance agents, carriers, the state—and you lose.” — Tom Quigley

“You’re buying health insurance like you’re buying gas from a station that just doubled its price—and thanking them for it.” — Tom Quigley

👉 Website: www.ClaimLinx.com

In this special Halloween edition of the Cutting Edge Benefits Podcast, Tom Quigley and Neil Haley dissect breaking news from the healthcare industry: CVS Health’s shocking decision to exit the ACA individual marketplace in 17 states for 2026. While some may see this as an isolated corporate move, Tom argues it’s a clear reflection of a profit-obsessed system collapsing under its own weight.

With his trademark candor, Tom calls out the real motives behind CVS’s exit—profit margins and shareholder demands—not consumer care or innovation. He breaks down how the ACA individual market became an unprofitable “loss leader” for major corporations, likening CVS’s health plans to the cheap gas at a convenience store—a hook to get people in the door to buy other stuff.

Throughout the conversation, Tom and Neil use sharp analogies, humor, and blunt truth to expose the dysfunction in the current system and guide business owners on how to protect their teams from market chaos in 2026 and beyond.

1. Why CVS Really Exited the ACA Market

   • CVS Health, through Aetna, wasn’t earning enough profit to satisfy shareholders.

   • Tom: “They’re stock companies. If they’re not making enough for their shareholders, they’re gone—goodbye, see you next.”

   • Their ACA product featured limited networks and underperforming teams—“probably former failed insurance agents,” Tom jokes.

2. The Corporate Game: It’s All About the Store Traffic

   • CVS’s goal wasn’t to revolutionize health insurance—it was to get more people into the store.

   • Tom compares their strategy to gas stations offering cheap gas to sell snacks and drinks.

   • “Drugs were their loss leader,” Tom says. “They wanted you to come in for prescriptions, then leave with almonds, ice cream, and a passport photo.”

3. Impact on Employees and Consumers

   • Those with CVS/Aetna ACA plans will have to switch to other carriers in their state.

   • Some states, like Kentucky, have only two carriers left, making this exit more significant.

   • Still, Tom emphasizes: “It’s just one more carrier playing the profit game—it’s not about care, it’s about stock price.”

4. Deeper Instability or Business as Usual?

   • CVS’s move doesn’t signal a total collapse but highlights systemic instability where insurers chase higher-profit markets.

   • “They might make 10% profit, but they want 20%. It’s never enough,” Tom explains.

5. How Small Businesses Can Protect Their Teams

   • Tom urges business owners to change their mindset: buy catastrophic insurance only, then fund the rest of the benefits directly.

   • “Stop chasing headlines. You’re not buying insurance—you’re building benefits,” he says.

   • ClaimLinx’s approach helps businesses control their own benefits, avoiding disruptions caused by insurer shifts or government subsidies.

6. Lessons from the Corporate Health Shuffle

   • Large insurers view health coverage like CVS views snacks—it’s about upselling.

   • Insurance companies want you to add dental, vision, and extras that bring pure profit.

   • “They want impulse buyers,” Tom says. “If everyone only bought what they needed, the whole agent system would collapse.”

7. The November Crunch: Renewals and Subsidy Changes

   • With subsidies set to sunset, fearmongering headlines will explode—but Tom insists it’s just political theater.

   • “They’ll adjust the premiums, move a few numbers, and make it sound like the world’s ending,” he quips.

   • His advice? “Ignore the noise. Focus on your business’s balance sheet.”

“If you’re smart, you buy catastrophic insurance and fund benefits yourself. Everyone else is just impulse-buying health care.” — Tom Quigley

“It’s all buzzwords and headlines—CNN, MSNBC, they love scaring people. I love saving them instead.” — Tom Quigley

👉 Website: www.ClaimLinx.com
📞 Schedule a Call: Talk to Tom Quigley and his team to find out how your company can cut costs and improve benefits for 2026 and beyond.

Stay ahead of healthcare disruption with the Cutting Edge Benefits Podcast, where Tom Quigley and Neil Haley deliver straight talk on how to beat the system, save money, and empower your employees.