CHICAGO — Illinois residents will pay an average of 78% more across the state for health insurance through the Affordable Care Act exchange if Congress does not extend enhanced premium tax credits — the issue at the heart of the current government shutdown — state regulators said Monday.

Illinois residents who have health insurance through the exchange will begin receiving letters this week from the Illinois Department of Insurance outlining how their costs may increase next year, said Morgan Winters, director of Get Covered Illinois, the state’s new marketplace for Affordable Care Act plans.

About 91% of Illinois residents with exchange plans get the enhanced premium tax credits, which lower the monthly costs of their health insurance, said Ann Gillespie, director of the Illinois Department of Insurance.

“Some of them are going to lose their coverage entirely,” Gillespie said of what will occur if the enhanced subsidies are allowed to expire. “But everybody is going to be hit by this.”

Statewide, households this year are paying an average of $260 a month for coverage through the exchange, according to the Illinois Department of Insurance. Next year, if the enhanced credits expire, that average monthly rate will jump to $464.

Costs are expected to increase more or less for some Illinois residents, depending on which plans are offered where they live. Cook County residents would see their monthly premiums rise by 95% next year, on average; Lake County residents would see a 47% increase; DuPage County a 71% increase; Will County an 83% increase; and Kane County a 66% increase.

Most people in Illinois get health insurance through their employers, Medicare or Medicaid. The Affordable Care Act exchange provides an insurance-buying option for people who don’t get coverage through work, who are too young for Medicare and/or who make too much money to qualify for Medicaid. This year a record 550,000 Illinois residents enrolled in Affordable Care Act exchange plans, according to the Illinois Department of Insurance.

Most people who get insurance through the Affordable Care Act exchange also get premium tax credits, based on their incomes, to help lower the monthly costs of the insurance. In 2021, Congress passed a law to make the subsidies more generous and to expand them to more people.

Those more generous subsidies are now at the center of the government shutdown fight. Democrats are refusing to agree to reopen the government until Republicans agree to extend the enhanced subsidies beyond 2025.

Democrats say that without the enhanced subsidies, many people won’t be able to afford health insurance, and those who do still buy Affordable Care Act exchange plans will face much higher prices. For example, if the enhanced subsidies expire, people with incomes at more than 400% of the federal poverty level — $60,240 for an individual and $128,600 for a family of four this year — will no longer qualify for subsidies. People with lower incomes will still likely qualify for subsidies, but lower ones that what they now receive.

Meanwhile Republican House Speaker Mike Johnson has called the enhanced credits “a boondoggle” that is subsidizing “bad policy,” and has said that if they’re continued, they need “real reform.” He has said an extension of enhanced subsidies doesn’t belong in a government funding bill.

Open enrollment for Affordable Care Act exchange plans begins for Illinois residents Nov. 1 on the state’s new exchange at GetCoveredIllinois.gov and runs through Jan. 15. Illinois recently gained approval from the federal government to transition to a state-run exchange rather than use the federal one at HealthCare.gov.

By operating its own exchange, Illinois leaders expect to have more flexibility, such as by being able to help people more easily move between Medicaid and exchange plans, as their income changes, and by potentially being able to open up more special enrollment periods for Illinois residents. The state plans to allow pregnant women to enroll in exchange plans no matter the time of year, and will allow uninsured Illinois residents to enroll when they file their state income taxes, Winters said.

He said the state could also open a special enrollment period if the federal government decides to extend the enhanced subsidies after regular open enrollment has closed.

If the federal government decides to extend the enhanced subsidies after Illinois residents have already bought plans, the state will work with insurance carriers to make sure people see the savings next year, Winters said.

“We encourage people to not wait (to sign up for plans),” Winters said. “What I can assure you is the minute Congress acts, we will be hard at work implementing those subsidies.”

The Illinois Department of Insurance first unveiled the large proposed increases by health insurers several months ago, with insurers assuming that the enhanced premium tax credits would expire. In filings with the state, insurance companies pointed to the expiring enhanced subsidies, as well as growing health care costs and increasing use of health care services, as reasons for the increases. Experts expect that if the enhanced subsidies expire, young, healthy people may decide coverage is too expensive and forgo getting health insurance altogether, driving up costs across the board. Healthy people are cheaper for health insurance companies, and the companies rely on their participation to help balance out the costs of insuring sicker people.

Pharmaceutical tariffs and inflation are also playing a role in the higher rates, Gillespie said. She also noted ripple effects of Medicaid cuts within the One Big Beautiful Bill, signed into law in July by President Donald Trump. Though many provisions of that bill have not yet taken effect, hospitals will likely have to increase the rates they charge health insurance companies for services to help compensate for the Medicaid cuts, Gillespie said.

Several insurers are also leaving the exchange in Illinois for 2026. Aetna CVS Health, Health Alliance and Quartz will no longer offer exchange plans in Illinois for next year, and Cigna Healthcare of Illinois will no longer sell marketplace plans in Cook County, though Cigna plans will be available in other parts of the state.

_____

©2025 Chicago Tribune. Visit chicagotribune.com. Distributed by Tribune Content Agency, LLC.