Column: Worries Amp Up As Aca Enrollment Nears Amid Political Standoff Over Tax Credits

As Get Covered Illinois, the Illinois marketplace for Affordable Care Act health insurance plans, gears up for open enrollment in less than three weeks, worries and uncertainty abound over whether consumers ultimately will lose government subsidies and be hit with huge cost increases.

Congressional Democrats are continuing to fight for extension of the subsidies as a condition for their support of a Republican-backed continuing resolution that would reopen the federal government, which is now in the third week of a shutdown.

“People are very worried,” said U.S. Rep. Robin Kelly, a Democrat from Matteson. “They are very worried about if they have private insurance if that’s going to go up. They’re worried about losing their ACA subsidies, about Medicaid. My district is urban, suburban and rural, and no matter where people live, they’re all concerned.”

Affordable Care Act marketplace premium payments across the country would more than double on average next year if the subsidies, which are enhanced premium tax credits, expire at the end of this year. That’s according to an analysis by the nonpartisan Kaiser Family Foundation.

The expiration of the tax credits will cause an estimated 22 million Americans to experience an increase of more than $1,000 annually in costs, according to Kelly’s office. Kelly is on the House Energy and Commerce Health Subcommittee, Congress’ main policy writing institution for healthcare legislation, and she chairs the Congressional Black Caucus Health Braintrust. In Kelly’s Second District, 15,000 people will experience skyrocketing premium costs if the subsidies expire, according to her office, which shared these examples:

·         For a family of four earning $64,000 a year, annual premiums will increase by more than $2,571.

·         For a family of four earning almost $130,000 a year, annual premiums will increase by $8,533.

·         For a 60-year-old couple earning $82,800 a year, annual premiums will increase by $16,637.

“There are a lot of unknowns due to the Trump Administration’s federal policy changes,” said a spokesperson for Get Covered Illinois. “What we do know, and what will be incredibly impactful for 90% of our customers, is that the enhanced premium tax credits are going away unless Congressional Republicans join Democrats to extend them. Because of this, customers, on average, will see a $1,500 a year increase in their monthly health insurance premium.”

While tax credits will still be available, they will be less generous and will be available to fewer people, the spokesperson said.

Some 466,000 people in Illinois enrolled through the marketplace last year, a 17% jump from the prior year. The state expects a possible 35% drop in enrollment if the enhanced tax credits expire, increasing the overall uninsured rate in Illinois.

Enhanced premium tax credits were introduced in 2021 and later extended through the end of 2025 by the Biden administration’s Inflation Reduction Act. The enhanced tax credits increased the amount of financial assistance already eligible Affordable Care Act marketplace enrollees received and made middle-income enrollees with income above 400% of federal poverty guidelines newly eligible for premium tax credits, the Kaiser Family Foundation noted.

Since the introduction of the enhanced premium tax credits, enrollment in the Marketplace has spiked from about 11 million people to more than 24 million people. Currently, 92% receive an enhanced premium tax credit, and about half of adults with Affordable Care Act marketplace coverage are small business owners, employees, or self-employed according to the foundation.

Get Covered Illinois joined 18 other state-based health insurance marketplaces in March in issuing a joint letter to Congressional leaders urging them to extend the credits.

“If Congress fails to extend the health care tax credits, millions of Americans will face immediate and severe premium increases, leading many to forgo coverage altogether,” a spokesperson for America’s Health Insurance Plans, the trade association representing the health insurance industry, said Friday. “Congress must act as quickly as possible to protect Americans from this affordability crisis.”

Citing Congressional Budget Office data, the association said 2.4 million people will lose marketplace coverage by 2034 if the subsidies expire.

As people drop coverage, that puts their health at risk and means more people will show up at emergency rooms sicker and lead to longer waits in emergency rooms, said Kelly. As healthier people opt not to get coverage because of high premiums, the ripple effect is expected to drive up the cost of health insurance in the broader market as well, proponents of continuing the tax credits say.

Asked how insurers are preparing for Affordable Care Act open enrollment given the unknowns, the spokesperson said the situation is dynamic. It depends on a number of hypotheticals, including whether states have allowed or will allow plans to resubmit rates under a new scenario, the timing of open enrollment as well as ultimately consumers choosing to enroll based on what coverage options are available.

Blue Cross and Blue Shield of Illinois, which has roughly 235,000 members in Affordable Care Act plans in Illinois, including in the south suburbs, said it’s closely monitoring the fluid situation as it prepares for open enrollment.

Asked what the impact on the cost of premiums in Illinois will be if the subsidies are lost, Mark Tomaszewski, vice president, Individual and Family Market at Blue Cross and Blue Shield of Illinois, said in a statement, “The rates for 2026 coverage include both new and current individual ACA-compliant plans and reflects industry-wide changes to the market, including the anticipated expiration of enhanced premium tax credits at the end of 2025. Plans are priced to reflect anticipated health care needs.”

He said the company remains steadfast in its commitment to a stable health insurance market with competitive plan choices in the individual market.

Affordable Care Act open enrollment begins Nov. 1 and runs to Jan. 15. Get Covered Illinois, which previously operated as a branded portal to access Healthcare.gov, is launching its own state-based marketplace this year. So, Illinoisans seeking marketplace coverage will now enroll at GetCoveredIllinois.gov, not HealthCare.gov. The federal shutdown does not affect the state’s transition to a state-based marketplace.

Plan renewals will be sent to consumers at the end of this month, according to Get Covered Illinois. For plan year 2026, there are seven health insurers and 1,142 certified Quality Health Plans for sale in Illinois. The total number of plans available to consumers depends on where they live.

While the expanded tax credits are still set to expire, some tax credits will be available, and Get Covered Illinois is the only place to get them, the spokesperson said.

The state’s certified broker and navigator directory will launch on GetCoveredIllinois.gov on November 1. Customers can use that directory to find a broker or navigator near them. They can search by zip code and find brokers or trained navigators that speak their preferred language. Enrollment assistance is free. For more information, visit GetCoveredIllinois.gov or call 866-311-1119.

Francine Knowles is a freelance columnist for the Daily Southtown.

Fknowles.writer@gmail.com