The open enrollment campaign for Rhode Island’s health insurance marketplace usually promotes affordability.
Not this year.
“In the past we’ve been saying, ‘Health care is more affordable than ever before, so take a look and check it out,” Lindsay Lang, HealthSource RI’s director, said in an interview Thursday. “Now we’re really sticking to a message of, ‘We want to make sure you have coverage.’”
That’s because the low or no-cost premiums available to many of the 48,000 people covered through the state insurance marketplace are set to expire at the end of the year, barring action by Congress. Without the pandemic-era federal tax credits, HealthSource RI participants are expected to see their monthly premiums double, on average, from $109 to $220 a month, according to an Oct. 30 analysis by the Rhode Island Executive Office of Health and Human Services.
Democratic officials frame the looming premium spikes in dire terms, warning of the tough choices that low and middle-income families will face. Lang acknowledges the challenge, too. But, unlike political leaders, Lang needs to make sure marketplace enrollees know what’s coming, and why maintaining health insurance still matters.
“There’s a fair amount of this we cannot control,” Lang said. “What we can do is show up and be available and provide good reliable information to support as clear decision making as can be done in this environment.”
Lang and other state health care administrators have spent months preparing. They changed the ad campaigns blanketing airwaves, billboards and screens, staffed up the East Providence call center with extra workers, and held virtual and community events.
Six days in, calls are “a tick higher,” than in previous years. But it’s too early to put much stock in initial call volumes, Lang said.
Enrollment numbers don’t provide much insight yet either: All existing enrollees were already automatically renewed for their same plan next year unless they already signaled they wanted to make a change. The real marker will come Dec. 23, when the 44,000 auto-renewed participants have to make their first payment to stay on marketplace insurance next year.
HealthSource RI estimates 13,000 current enrollees will drop coverage when federal tax credits expire at the end of the year. It’s a fate Lang and her team are trying their best to minimize by focusing on the more limited federal tax credits that will still be available even after the year ends.
A 40-year-old Rhode Island adult who earns $30,000 per year, for example, can still get $351 in monthly tax credits, reducing their annual premium for a “silver” - or second-tier - insurance plan to $158 per month, according to HealthSource RI.
Younger and middle-income enrollees will see the highest monthly premium increases, up to $333 more on average for an adult who earns more than $62,600, based on 2025 federal poverty guidelines.
Rather than opting to forgo insurance entirely, Lang hoped to convince people to keep a less expensive, and less expansive, marketplace plan.
“We’re still offering a high-quality product,” Lang said. “We understand how stressful this is, but we’re resolved to be here no matter what.”
As of October 2024, Rhode Island boasted the sixth-highest insured rate of any state in the country, with nearly 98% of residents covered. Returning to pre-Affordable Care Act days, when more than 11% of the state population lacked any form of health insurance, could have dire consequences well beyond state bragging rights.
“You can’t have a healthy thriving economy at the state level without a steady and reliable health care system, and our health care system is already under enormous pressure,” Lang said.
More uninsured people will drive up demand for costly emergency room services and simultaneously reduce federal funding to the tune of $70 million a year - dollars ordinarily funneled back to health care providers and hospitals, according to EOHHS’ report.
Younger and healthier people are most likely to drop coverage, leaving a pool of older, sicker and more medically expensive enrollees for commercial health insurers to cover. Blue Cross Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island, the two insurers that cover marketplace enrollees, sought record high premium increases partly because of the costs associated with covering a riskier pool of plan participants.
Rhode Island Health Insurance Commissioner Cory King, whose office is charged with reviewing and approving annual commercial insurance rates, shaved $59 million off what insurers wanted. But the approved 2026 premiums for marketplace enrollees are still 20-22% higher than 2025 — even before waning federal subsidies.
While public sentiment may be less sympathetic toward health insurers, company financials impact what they can pay health care providers. Rhode Island’s lower reimbursement rates compared with neighboring states are widely blamed for the shortage of primary care providers, along with other medical specialties.
Democratic state and federal elected officials continue to apply pressure in D.C. in the hopes of convincing the Republican-led Congress to extend the federal discounts for marketplace insurance.
Gov. Daniel J. McKee called on President Donald Trump to “get his party to the table” in a statement Monday, while U.S. Sen. Jack Reed called the president’s health care policy “a cruel joke” in a separate statement the same day.
“As open enrollment begins, many Rhode Islanders are being forced to make impossible choices: between affording health care next year and necessities like food and housing,” U.S. Rep. Gabe Amo said in an Oct. 31 statement. “It’s time for Trump and Republicans to demonstrate they care by moving quickly to negotiate with Democrats to reopen the government and lower health care costs.”
If Congress extends the federal tax credits, it will cause short-term administrative burdens for Lang’s 16-person team to recalculate monthly premium costs and let people know about the discounted rates.
But, “it would be a great problem to have,” Lang said.
She continued, “This is a challenging year in that we feel the pain on behalf of our customers in a really visceral way.”
Nancy Lavin is a senior staff writer for the
Rhode Island Current.
