Health

60,000 Chicagoans Expected to Lose Coverage if Enhanced Health Care Subsidies Expire in December

About 4.8 million people are expected to lose their Affordable Care Act coverage in 2026 if Congress does not extend a set of enhanced subsidies created under the Inflation Reduction Act in 2022. That includes 100,000 people in Illinois, about 60,000 of whom live in Chicago.

Without the subsidies, the average premium paid by an enrollee is expected to more than double — from $888 per month in 2025 to $1,904 in 2026.

People enrolled in ACA plans could lose $30 billion in subsidies that now help cover their health insurance costs, according to Anuj Gangopadhyaya, a professor of economics at Loyola University.

“You just took out a bunch of federal subsidies that cost on the order of $30 billion a year,” Gangopadhyaya said. “So that’s $30 billion out of the system, and people are going to either have to pay for it or they’re gonna have to choose not to take the insurance coverage up at all.”

The subsidies lowered premium costs — in some cases to zero for low-income enrollees — and eliminated the 400% of the federal poverty level cap on eligibility, causing enrollment in the ACA marketplace to double from about 12 million in 2021 to 24 million in 2025. 

“What those dollars did is for people who currently had plans, they got even more subsidies, all else equal,” Gangopadhyaya said. “But it also impacted new families who were previously ineligible who earned too much money before to be eligible for these discounts, these subsidies, have now become eligible as well. Those are the folks who are on the hook for not benefiting anymore if these aren’t extended.” 

Lawmakers from both parties have called for extending the subsidies before open enrollment begins Nov. 1, when buyers will see premium prices that assume the aid has expired. 

That sticker shock could push buyers to look for insurance elsewhere — or to forgo coverage entirely, according to Gangopadhyaya.

Get Covered Illinois, which transitioned this year from the federal exchange to a state-based marketplace, could give Illinois residents more flexibility, said Ann Gillespie, director of the Illinois Department of Insurance.  

“Moving to a state-based marketplace gives us a little more flexibility with regard to things like special open enrollment periods,” Gillespie said. “I think consumers will have more opportunity to find a plan that works for them than they would if we were still on the federal exchange, because our navigators have been trained to deal with specific Illinois concerns.”

Those enrolled through Get Covered Illinois will have access to two additional special enrollment periods — one during pregnancy and another when individuals file their taxes.

People enrolling in ACA marketplace plans are typically from the middle class, according to Wendy Epstein, a professor of law at DePaul University.

Other alternatives are limited for people in this group, who often don’t qualify for Medicaid or Medicare and can’t afford employer-sponsored insurance.

“The first step is always to check to see if you’re eligible for Medicaid,” Epstein said. “We have relatively generous Medicaid coverage in Illinois. If they do have access to employer-sponsored insurance, it would cost them too high of a percentage of their monthly income. I think that’s not going to be an option for most folks.”

---