Lindsay Lang’s morning doomscroll has become something of a compulsion.
As she gets out of bed, the HealthSource RI director can’t help but reach for her phone, combing through news headlines and social media feeds in case there’s an update on the federal tax credits for health insurance through the Affordable Care Act. The pandemic-era discounts are set to expire at the end of the year. Without them, monthly premiums will double, from $109 to $220 a month on average, for the 48,000 Rhode Islanders covered through the state insurance marketplace, according to a state analysis.
HealthSource RI estimates 13,000 current enrollees will drop coverage when federal tax credits expire at the end of the year because of the increased cost.
Unless Congress can agree to extend the subsidies — breaking the monthslong stalemate that was a driving force behind the 43-day federal shutdown.
Lang isn’t hopeful.
But, “things have changed on a dime before” she said in an interview Thursday.
Rhode Islanders are also watching Congress with a close eye ahead of the looming deadline to start or continue health insurance coverage through the state marketplace.
Preliminary information published on Dec. 5 by the Centers for Medicare & Medicaid Services suggests that participation in individual marketplace health insurance plans remains on par with prior years: nationwide, 4.8 million consumers have returned, joined by 950,000 new enrollees.
In Rhode Island, more than 2,700 people signed up for marketplace health insurance for the first time, while over 41,000 existing participants returned, according to federal data.
Lang doesn’t put much stock in the CMS report, at least for returning customers, because they were automatically renewed for coverage at the start of open enrollment on Nov. 1.
“It’s really hard to know where we’ll land until after that first payment deadline,” Lang said.
Lang felt more confident about the staying power of those who just signed up.
“It’s safe to consider new enrollment folks are a bit more active shoppers,” she said. “They haven’t received the federal subsidy before.”
Going for bronze
Among new participants, more are choosing less expansive — and expensive — coverage. More than 1 in 4 new enrollees have chosen a “bronze” medal health plan, which has the lowest premium of the four tiers, but typically much higher deductibles and fewer services covered. By contrast, 16% of participants who signed up in 2025 chose bronze medal plans, while nearly one-third opted for gold medal plans — the second-highest coverage.
Lang expected returning customers would also choose to downgrade their coverage from platinum or gold medal plans to silver or bronze, although data was not available.
HealthSource RI sent out invoices to new and returning plan participants last week. Most have not made payments or put a credit card on file yet.
But they are asking questions, flooding the phone lines of the East Providence call center and quickly filling the virtual enrollment time slots to try and comprehend why their health insurance costs so much more.
“We’re definitely having conversations about shock, concern, needing more time to process this information,” Lang said. “People are asking ‘is this number I’m seeing in my renewal notice right? Is there anything I can do to change it?’”
No longer able to tout the state insurance marketplace as affordable, Lang and her team have instead shifted their messaging to the importance of maintaining health insurance coverage.
We’re definitely having conversations about shock, concern, needing more time to process this information. People are asking ‘is this number I’m seeing in my renewal notice right? Is there anything I can do to change it?’
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.
In 2024, Rhode Island hospitals provided more than $84 million in uncompensated care for people without insurance, according to the Hospital Association of Rhode Island. The trade group representing Rhode Island hospitals warned in a Dec. 8 statement that “even a fraction” of newly uninsured people heading to emergency rooms, inpatient units or outpatient clinics will cause hospital costs to climb sharply, jeopardizing their financial stability and service.
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 company expenses associated with covering a riskier pool of plan participants.
D.C. stalemate
“It’s driving up costs for everyone, no matter where they get their care,” U.S. Rep. Gabe Amo said in a Dec. 3 statement, following a virtual town hall with Lang.
Amo, like the rest of Rhode Island’s Democratic congressional delegation, has placed blame squarely on congressional Republicans and President Donald Trump for further straining the health care system.
“If Republicans in Congress refuse to act, people in their states aren’t going to be able to afford coverage,” U.S. Sen. Jack Reed said in a statement on Dec. 10. “And without coverage, the sad fact is some will not survive. So I hope my Republican colleagues will listen to their constituents and act in their best interests.”
The U.S. Senate failed to pass competing health care bills Thursday, Reed and U.S. Sen. Sheldon Whitehouse voted for the Democratic bill, which would have extended the federal tax credits for three years, and against the Republican bill, which would add funding to Health Savings Accounts for marketplace enrollees.
“Today’s vote is just one more data point showing the American people that Republicans are inexplicably hostile to their own constituents having high-quality health care,” Whitehouse said in a statement.
Peter Marino, CEO and president for Neighborhood Health, also expressed disappointment in the congressional stalemate.
“This inaction has real consequences: thousands of Rhode Islanders who relied on these credits as a lifeline to affordable health care coverage may now face the unthinkable choice of going without coverage for themselves and their families,” Marino said in a statement Thursday. “Despite today’s setback, Neighborhood remains steadfast in our mission to advocate for accessible, cost-effective, and equitable health care for every member we serve. ”
Reed also pledged to continue pushing for the federal tax credits.
“The tricky part is, there’s a lot of talk but just a few actual proposals out there,” Lang said.
Also challenging: planning for the local impact of eleventh hour federal actions. If Congress extends the tax credits, or reconfigures them, Lang’s 16-person team would have to recalculate monthly premium costs, giving existing or prospective enrollees the option to enroll, renew or change plans.
It might also affect the commercial insurance rates approved by Rhode Island Health Insurance Commissioner Cory King, who granted increases for 2026 commercial premiums due in part to expiring federal tax credits. More than 20% of the requested hike by Blue Cross, for example, stemmed from the expiration of enhanced federal subsidies.
“If we can lower the rates, we’d want to lower the rates,” King said in an interview with Rhode Island Current at the start of open enrollment in November. “And do it as quickly as humanly possible.”
This story was orginally published by the Rhode Island Current.
