Thousands of Rhode Islanders dropped their health plans through the Affordable Care Act (ACA) during the three months that ended Jan. 31, resulting in a “highly unusual” 20% decrease in enrollments for 2026, according to a state report released Monday.
State officials attributed the decline to rising premiums and the reduction in federal subsidies in the form of enhanced premium tax credits. Enacted during the COVID-19 pandemic, the tax credits helped millions of middle-class Americans pay for their ACA health plans. But those credits expired on Dec. 31, after Congress failed to reach an agreement during the government shutdown.
The loss of the subsidies, coupled with rising health care costs, drove up premiums on state exchanges nationwide, leaving families to agonize over how to pay for coverage.
The new 2026 state open enrollment data offers the first look at the impact of the loss of federal subsidies in Rhode Island.
About 16,000 enrollees in the state exchange dropped their coverage for 2026, Christina O’Reilly, a HealthSourceRI spokeswoman, said in an email. The decline was off-set by about 6,500 new customers, she said, resulting in a net decrease in enrollment of about 9,500 – down 20% from the 48,000 when enrollment opened on Nov. 1, 2025.
“It’s gut-wrenching to see these types of numbers,” Lindsay Lang, director of HealthSourceRI, the state’s insurance exchange, said in an interview. “And I am concerned that we will see some additional attrition as folks … contend with the many pressures on their household budgets.”
In Rhode Island, monthly premiums for 2026 ACA health plans doubled, on average, compared with last year. Lower-income households, the report said, were among the hardest hit, with monthly premiums for some single-adult households up more than 300%.
The loss of federal ACA health insurance subsidies, along with anticipated federal cuts to Medicaid, has leaders of the state’s nonprofit community health centers bracing for an influx of newly uninsured patients.
“It feels a little bit like it’s the coming of a tsunami,’’ said Elena Nicolella, president and CEO of the Rhode Island Health Center Association, a trade group representing the state’s eight federally qualified health centers. “It feels like there’s only so much you can do to prepare for an onslaught like this.”
The group projects that the health centers’ uninsured population in Rhode Island could more than double, Nicolella said, from about 9% to 18% or 20% of their patients.
For people without coverage, health centers offer a sliding scale with payment plans, and prescriptions for lower-cost generic drugs. But every additional uninsured patient means less revenue for the health center and the financial burden has put nonprofit health centers at risk.
“Not only is it a financial disaster for us, it’s a fear that these people are not going to seek care,” said Craig McAnaugh, chief financial officer at Blackstone Valley Community Health Center.
For patients like Ms. Barbosa, going without coverage is risky. She is 48 and has high blood pressure and diabetes. (She agreed through a translator to talk to Ocean State Media if she was identified only by her last name, because of privacy concerns.)
Barbosa lives with her teenage daughter in Pawtucket and works full-time as a housekeeper. Her employer doesn’t offer health insurance, she said, so she has been buying coverage through the state exchange.
But in mid-January, she learned that the monthly premiums for her Silver plan would increase from $224 to $250 per month. With higher prices for food and gas, she said, even a $26-a-month increase in her monthly premiums was too much.
“Now it’s very expensive,’’ she said. She pays $1,400 a month in rent and she fills her gas tank twice a week, she said, because she drives to her job in Newport.
So Barbosa dropped her ACA health plan. To help reduce the cost of her check-ups and medications, she applied for the health center’s sliding fee discount.
She said she had about 1 ½ months worth of her medication left before she’d run out.
Governor McKee’s proposed budget includes $9.5 million to subsidize premiums for people who allowed their ACA coverage to lapse. If approved by the General Assembly, the funds are expected to help about 6,500 people who fall under 200% of the federal poverty level who allowed their coverage to lapse.
But even if state lawmakers approve McKee’s plan, Barbosa will likely be ineligible because her income is too high. Last year, she earned $43,700 – just under 250% of the federal poverty level for a family of two.
Lynn Arditii can be reached at lynn@lynnarditi.com
