PROVIDENCE – Following the expiration of the Affordable Care Act enhanced tax credits, enrollment in the state health insurance plans decreased 10% year-over-year as average monthly premiums increased by more than 100%.
From year-end through the end of the open enrollment period, which concluded on Jan. 31, enrollment decreased by 20% in what HealthSource RI, the state health insurance marketplace, called a "highly unusual development" after years of growth in this metric.
"It’s a concerning trend for sure, though not an unexpected one," said HealthSource RI Director Lindsay Lang, and one that falls in line with the agency's autumn projection that an additional 13,000 Rhode Islanders will go without health insurance coverage this year.
HealthSource RI enrollees saw their average monthly premiums increase by $111 per person, or 101%. The largest increases occurred among the lowest-income households: Those at the 150%-200% range of the poverty threshold, with an annual salary of $24,000-$31,000, saw monthly premiums spike from $40 to $137.
Among those who didn't drop coverage entirely, many chose to select a lower metal tier. Enrollment in bronze level plans, which offer the lowest monthly premiums but highest deductibles and out-of-pocket expenses, rose from $21% to 31%.
Silver and gold tier plans, meanwhile, decreased from 38% to 31% and 38% to 35%, respectively, after previously experiencing growth under pandemic-era enhanced tax credits.
Congress, led by Republican legislators, declined to renew these credits.
While the bronze plans may work for some, Lang said, others could struggle to pay even the lowered premiums when combined with higher out-of-pocket costs.
This "additional volatility for customers at the individual level (also) introduces more instability into the market," Lang said.
The state’s uninsured rate dropped by about two-thirds after the Obama-era Affordable Care Act went into effect in coverage year 2014, and in 2024 was among the lowest in the country, at 2.2%. But officials expect to see that figure rise, with the statewide health system and residents bearing the costs.
As federal tax credits expired, insurers throughout the U.S., including in Rhode Island, also increased premiums in response to anticipated uninsured rates.
“We can expect that the uncompensated care rate will increase,” Lang said, and “ultimately, that will have an impact on those in the market, as those costs ultimately get passed on to ratepayers.”
In response to the expiring insurance credits, Gov. Daniel J. McKee’s fiscal 2027 budget proposes a $9.5 million appropriation to subsidize coverage for the 20,000 residents hardest-hit by premium increases.
Those residents have an income that falls below 200% of the poverty level, Lang said. HealthSource RI estimates that it would regain about 6,500 enrollees with the appropriation.
While this year's open enrollment has concluded, Lang said that HealthSource RI will continue to prioritize connecting residents with all financial resources available. By keeping an up-to-date account, comparing plans and ensuring that HealthSource RI has all relevant information, Lang said, residents can ensure they're taking advantage of all assistance.
During the open enrollment period, the agency fielded increased calls as customers sought this guidance.
“One of our goals throughout all of this, but especially this year, is to make sure that when our customers are making these critical decisions about keeping their coverage or making a change to their coverage ... that they’re doing so with enough information,” Lang said.
Correction: An earlier version of this story gave an incorrect estimated number of enrollees who would regain coverage under Gov. Daniel J. McKee's $9.5 million proposal. The number is 6,500.
Jacquelyn Voghel is a PBN staff writer. You may reach her at Voghel@PBN.com.
