Introduction to the Government Shutdown
As the federal government shutdown approaches nearly a month, the fight over access to health care for Americans is at the center of the standoff between Republicans and Democrats. Democrats want to extend enhanced tax credits for people who use the Affordable Care Act marketplace that are set to expire at the end of the year. Experts say this will cause insurance costs across the country to skyrocket, forcing some to become uninsured. An estimated 24 million Americans now rely on the ACA, or Obamacare, to get their health insurance.
Democrats’ Push for Medicaid and ACA Extensions
Democrats are also pushing to reverse cuts to Medicaid enacted as part of President Donald Trump’s sweeping tax and policy bill passed this summer. U.S. Rep. Raja Krishnamoorthi recently toured Loretto Hospital in Chicago’s Austin neighborhood to hear about how changes to Medicaid could hit the hospital. He said the loss of the enhanced ACA subsidies could also ripple out to safety net hospitals and cause a “huge catastrophe.” The shutdown began Oct. 1 after Congress missed the deadline to fund the government. “Once they lose their health insurance, they’re going to go to the emergency rooms at places like Loretto, and then everyone’s health insurance premiums are going to spike,” he said.
What Tax Credits Are at Stake?
With passage of the Affordable Care Act, tax credits were used to reduce monthly premiums for low-income Americans, said Stephanie Altman, director of the health care justice team at the Shriver Center on Poverty Law. The credit size is based on income — the lower your income, the larger your credit. Then, in 2021 during the COVID-19 pandemic, an enhancement to the premium tax credit was added. It makes ACA plans even more affordable by creating deeper levels of financial assistance and offering reduced benefits to middle-class enrollees that phase out as income rises. The credit caps premium contributions as a percentage of income.
The Impact of the Enhanced Credit Expiration
But the enhanced credit is expiring, leaving only the premium credit. The enhanced credit allowed someone with income above 400% of the federal poverty level to use the premium tax credits at a reduced level, according to KFF, a health policy organization. That’s $128,600 for a family of four. This group will no longer receive the reduced subsidy unless the enhanced credit is extended. And critically, everyone who is still eligible for the regular credit is expected to pay more. “The problem was a lot of people were losing their jobs or not working,” said Robert Kaestner, a health economist at the University of Chicago’s Harris School of Public Policy. “They didn’t have access to employer provided insurance, which they usually would, so the expanded tax credits were just a way to kind of support people in this very unusual time.”
How Many People in Illinois Will Be Affected?
Across Illinois 465,985 people in 2025 bought their health insurance through the ACA, according to a letter penned by the Democratic Illinois congressional delegation. More than 395,000 of those people benefit from the enhanced premium tax credits, according to KFF. Though it’s hard to say exactly how many people will no longer be able to afford health insurance without the enhanced tax credit, an estimate by state officials predicts 70,000 to 90,000 people in Illinois will become uninsured, Altman said. This comes as people getting insured through the ACA has increased in recent years. In 2020, there were just 292,945 enrollees, according to the Illinois congressional delegation. Illinois saw a record 17% increase in enrollees last year, state officials say.
The Estimated Premium Increase
The estimated premium increase without the enhanced tax credit varies across the state. For example, it could range from $696 to $1,776 annually in Illinois, according to an analysis from the Center on Budget and Policy Priorities, a D.C.-based think tank. Enrollees are expected to have to contribute a larger share of their income toward an ACA plan, according to KFF. For example, a person making $28,000 a year will go from paying 1% to 6% of their income for an ACA plan. “It will not be as generous and for many people insurance will become unaffordable for them,” Altman said.
Get Covered Illinois
For the first time, residents in Illinois this year can sign up for the ACA in the new state-run marketplace called “Get Covered Illinois.” It launches Nov. 1, when open enrollment begins. Enrollment should not be impacted by a continued federal government shutdown because the marketplace is state-operated, Gillespie said. Illinois is investing in ACA navigators to help individuals find a health care plan, Gillespie said. The new marketplace will also have a 350-person call center with translation services. Gillespie is encouraging ACA enrollees who receive notices of rising premiums to take advantage of the new state services. While the state can’t make up for the loss of the enhanced premium tax credits, navigators and call centers workers can help people apply for Medicaid or try to find a more cost-effective plan, “that will suit their budget and their health care needs.” “So we really encourage people not to give up,” Gillespie said. Open enrollment runs from Nov. 1 to Jan. 15. You can call the center at 1-866-311-1119 or visit getcovered.illinois.gov.
Conclusion
The expiration of the enhanced tax credits for the Affordable Care Act marketplace is a pressing issue that could lead to increased insurance costs and a rise in uninsured individuals. Democrats are pushing for an extension of these credits, while Republicans have been resistant to the idea. As the government shutdown continues, it remains to be seen how this issue will be resolved. In the meantime, individuals can take advantage of state-run marketplaces like Get Covered Illinois to find affordable health care plans.
FAQs
Q: What is the Affordable Care Act (ACA) marketplace?
A: The ACA marketplace is a platform where individuals can purchase health insurance plans.
Q: What are the enhanced tax credits, and how do they affect ACA plans?
A: The enhanced tax credits make ACA plans more affordable by creating deeper levels of financial assistance and offering reduced benefits to middle-class enrollees.
Q: How many people in Illinois will be affected by the expiration of the enhanced tax credits?
A: An estimated 70,000 to 90,000 people in Illinois will become uninsured due to the expiration of the enhanced tax credits.
Q: What is Get Covered Illinois, and how can it help individuals find affordable health care plans?
A: Get Covered Illinois is a new state-run marketplace where individuals can sign up for ACA plans. It offers ACA navigators and a call center with translation services to help individuals find affordable health care plans.
Q: How can individuals enroll in Get Covered Illinois?
A: Individuals can enroll in Get Covered Illinois by visiting the website or calling the call center at 1-866-311-1119. Open enrollment runs from Nov. 1 to Jan. 15.
