A record 449,553 Illinois residents sign up for Affordable Care Act insurance, amid uncertainty over future

A record number of Illinois residents have signed up for Affordable Care Act health insurance plans for this year — amid uncertainties about the future of tax credits that lower the cost of those plans for most consumers.

In Illinois, 449,553 people selected health plans between Nov. 1, when open enrollment began, through Jan. 4, according to the federal Centers for Medicare & Medicaid Services. That’s already up 12.7% from last year, when 398,814 Illinois residents selected plans during the open enrollment period. Consumers still have until Jan. 15 to select plans at HealthCare.gov in order to get coverage for this year.

Most people in Illinois get health coverage through their employers, Medicare or Medicaid, but each year many others sign up for coverage through the Affordable Care Act (also known as Obamacare) at HealthCare.gov.

“It’s very exciting. We’re really pleased to see such large enrollment,” said Stephanie Altman, director of health care justice and senior director of policy at the Shriver Center on Poverty Law in Chicago. She said it’s good to see so many more people enroll just ahead of President-elect Donald Trump taking office, given that “we expect to see a lack of support and enthusiasm for the federal marketplaces again and the Affordable Care Act” under his administration.

One thing that’s up in the air after Trump’s win is the future of enhanced tax credits that many people in Illinois and across the country depend on to help them afford coverage. The amounts of the tax credits are based largely on income, and help lower monthly premiums for many consumers who buy Affordable Care Act plans.

Nearly 90% of Illinois residents with Affordable Care Act plans received the credits in 2023, according to the Illinois Department of Insurance. The federal government has said that for this year, it expects about 80% of HealthCare.gov customers to be able to find plans for $10 a month or less, with help from the tax credits.

Though consumers have long been able to receive tax credits under the Affordable Care Act, those subsidies were expanded with the passage of the American Plan Rescue Act in 2021. The Inflation Reduction Act then extended those higher subsidies through 2025.

But with Republicans now in charge at the federal level, it’s unclear whether those enhanced tax credits will remain available after 2025. Many Republicans have long been critical of the Affordable Care Act, calling it flawed and too costly, and President Donald Trump famously tried to eliminate it when he was last in office.

Supporters of the tax credits, however, say they’re necessary to keep health coverage affordable for Americans. The Congressional Budget Office recently estimated that if the enhanced tax credits are not extended, the number of people without insurance would rise by 2.2 million in 2026, and by 3.7 million people in 2027.

Rep. Lauren Underwood, D-Illinois, has introduced a bill that would make the enhanced tax credits permanent. Also, a coalition called Keep Americans Covered — which includes the AARP, hospital system Ascension and health insurance industry group AHIP among others —  is pushing for extending the enhanced subsidies.

Illinois is seeking to better insulate itself from changing politics at the federal level by transitioning to running its own health insurance marketplace. Last year, the state awarded $6.5 million to health care organizations, as part of a navigator program, to help enroll people in Affordable Care Act health insurance this open enrollment period. And during the next open enrollment period, consumers in Illinois will select plans from a state website rather than from the federal HealthCare.gov.

The new state-based marketplace could allow Illinois to give consumers more chances to buy health insurance. It should also make it easier for people to move between Medicaid and Affordable Care Act plans, as their income levels change, Altman said.

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