Without significant changes to the reconciliation package, coverage for more than 20,000 Rhode Islanders through HealthSource RI, and the stability of the individual market, could be impacted
PROVIDENCE – The recently-passed House reconciliation bill and the pending Senate bill would undermine progress made under the Affordable Care Act and jeopardize access to affordable health coverage for thousands of Rhode Islanders and millions of Americans according to analysis by national and local policy experts. A statement signed by HealthSource RI Director Lindsay Lang and 17 other bipartisan State-Based Marketplace Directors outlining the pressing need for changes before the finalization of the legislation was submitted to the Senate. A previous letter to the House and a subsequent letter to the Senate, each signed by the same group, can be viewed along with other impact summary documents on the website of the State Marketplace Network, a collective supported by the National Academy for Health State Policy.
Presently, more than 45,000 Rhode Islanders rely on HealthSource RI (HSRI) for access to high quality, affordable health coverage in the individual and family market. An additional 8,600 people and 1,200 small employers depend on HSRI for small group insurance.
Some of the ways in which the provisions presently under consideration would impact customers and reduce enrollment:
- Shortens the Open Enrollment period from 3 months in Rhode Island to 45 days for all states and federal marketplace
- Ends tax credit eligibility for many legal immigrant groups
- Ends automatic renewals, requiring more paperwork each year to renew and preventing enrollment until all paperwork is processed
- Requires more documentation for enrollments
HSRI has been a driving force in helping the state achieve a remarkably low rate of just 2.2% uninsured in 2024, down from 11% in 2012. Rhode Islanders turn to HSRI to gain high quality, affordable health coverage when they don’t have the option to enroll through their job, Medicaid or another typical source of insurance.
In recent years, Rhode Island leveraged the ACA and enhanced federal Advanced Premium Tax Credits (APTCs) to make improvements to how our residents get and stay covered with high quality health insurance. Recently, to keep residents connected to coverage through HSRI when their coverage through Medicaid was ending, the state enacted an innovative auto-enrollment program. Under the leadership of Governor Dan McKee, and with the support of the state legislature, this program allowed the state to reduce administrative burden and support smooth transitions from Medicaid to commercial coverage through HSRI. Now, the additional financial assistance that made this possible is set to expire at the end of this year, leaving HSRI enrollees facing increased costs when they transition off Medicaid or when existing customers renew their coverage for 2026.
Coupling the expiration of the enhanced tax credits with the effects of the proposed reconciliation bill, our state healthcare system and those who use it would face barriers. The Marketplace-related measures now under consideration take deep slices at the structural and financial viability of coverage under the Affordable Care Act. The effects of the legislative package, stacked on top of the loss of enhanced premium tax credits at the end of 2025, threaten to plunge HSRI’s enrollment from 45,000 to just 21,000 over the next several years. The corresponding increase in the state’s uninsured would be approximately 16,000.
“This legislation takes us in the opposite direction of where we want to be in Rhode Island, and the harm it could do, in combination with the expiration of the enhanced tax credits our customers have relied upon, cannot be overstated,” said Lang. “The impact this reconciliation package would have – barriers to enrollment, unnecessary red tape and jacking up the cost of coverage – will undercut the very mission of HealthSource RI. The large losses in health coverage and affordability projected under this bill will have immediate ripple effects throughout our health care system and for years to come.”
Simply put, the bill makes health coverage harder to get, more difficult to keep and far too expensive to afford. The effects of the bill will compound each year, likely resulting in significant rate increases for anyone still left in the market. Overall, the Senate bill’s health policy provisions hue closely to and build on the policies included in the House-passed bill, according to analysis by Manatt Health published by Princeton University’s State Health & Value Strategies.[i] If further changes are not proposed in the Senate and then resolved with the House-passed bill, these detrimental effects to customers who depend upon the coverage provided through the Affordable Care Act would become law.
The Congressional Budget Office estimates that the expiring enhanced APTCs, reconciliation bill, and regulatory changes as proposed (updates with the finalized June 20 CMS rule are not yet published) will combine to reduce national expenditures by an average of $80B over the next 10 years. The annual cuts amount to more than half of the current 2025 national expenditures on APTCs of approximately $145B that support this critical Affordable Care Act program. HealthSource RI has developed some preliminary estimates on the impact of these provisions on Rhode Islanders.
Preliminary Estimates for Impact on RI of Upcoming Marketplace Provisions:
Including expiring enhanced APTC (eAPTCs), combined with the reconciliation bill provisions, broken out between the House Ways & Means (W&M) and Energy & Commerce (E&C) committees, as well as a late change to Cost-Sharing Reductions (CSR) that could further reduce affordability.
If no changes are made, the effects would begin to be felt among HSRI customers as early as Fall 2025, but will be noticeable across the health care system starting in January 2026. A recent report from the Urban Institute projects a decrease in health care spending of $1.03 trillion between 2025 and 2034, three-quarters of which is attributable to the House-passed reconciliation bill. Forty percent of that would impact hospitals ($408 billion) and eleven percent would hit physician services ($118 billion). Further, the report indicates that for the same time period, uncompensated care would spike $278 billion, most of which would be due to the reconciliation bill, and again most of that increase would be attributable to hospital services ($83 billion), followed by physician services ($34 billion). While each of the proposed changes to ACA provisions chisel away at its effectiveness and efficiency, taken together, these changes interact with and compound on one another, harming customers and the system underpinning the offering of affordable health coverage.
HealthSource RI is the state’s health insurance marketplace. It’s our mission to help Rhode Islanders easily navigate the complex health insurance landscape and enroll in a plan that works best for their individual and family needs. Since 2013, HealthSource RI has decreased the uninsured rate by more than two thirds. Today, nearly 98 percent of Rhode Islanders have health coverage, the sixth highest insured rate in the country. HealthSource RI is the only place Rhode Islanders can receive financial help to pay for their health coverage. Currently, 6 out of 7 HealthSource RI customers receive financial assistance.
