State-based health insurance marketplace opens amid federal budget stalemate

SPRINGFIELD — People in Illinois who buy health insurance through the Affordable Care Act marketplace are likely to see big increases in the cost of their premiums next year, but state officials are encouraging them to reach out for help before they decide to drop their coverage.

"We're really encouraging people, don't walk away. Come and talk to a navigator," Illinois Insurance Director Ann Gillespie said in an interview this week. "Make an appointment to talk to a navigator, because there are over 1,100 plans that we're going to be offering on the marketplace. There might be an option that will be affordable for you."

Open enrollment for the 2026 plan year begins Nov. 1 and runs through Jan. 15. This year will be the first year in which Illinois residents will use a state-based online platform, Get Covered Illinois, to shop for their plans.

"Last year, we were a state-based marketplace, but on the federal platform still. It was our transition year," Gillespie said. "So last year was technically the first year of the state-based marketplace. This year, we're on our own platform for the first time."

Federal budget battle

The premium hike is the result of a federal budget change that was included in President Donald Trump's domestic policy agenda known as the "One Big Beautiful Bill Act." That provision ends the enhanced tax credits that subsidize the cost of premiums for people who meet income guidelines.

Premium tax credits have always been part of the Affordable Care Act since it was passed in 2010 as a tool to reduce the out-of-pocket cost of plans sold on the exchange. They were available to households with incomes up to 400% of the federal poverty level, or $128,600 in 2025.

Congress first passed the enhanced credits in 2021 as part of the American Rescue Plan Act, an economic package passed in response to the COVID-19 pandemic. They were renewed in 2022 as part of another pandemic-related law, the Inflation Reduction Act.

The ending of those enhanced credits is now at the center of the ongoing federal budget stalemate in Congress, which prompted the partial shutdown of the federal government that began Oct. 1.

That day marked the start of a new federal fiscal year, but so far Congress has been unable to pass the spending bills needed to fund most of the government's day-to-day operating costs.

Republicans, who hold majorities in both chambers of Congress, have proposed passing a short-term "continuing resolution" that would keep the government running at currently-approved levels — which would include the scheduled ending of the enhanced tax credits — but most Democrats have insisted that any new spending plan include restoring the enhanced tax credits.

Impact in Illinois

In January 2025, an estimated 466,000 people in Illinois were covered by ACA marketplace plans. Of those, Gillespie said, about 90% received some amount of tax credit to subsidize their premiums. But she said ending the enhanced credits could cause people's out-of-pocket premium costs to rise, possibly forcing many people to drop their coverage.

"Premiums are going to go up nationwide as a result of this," she said. "People are going to be seeing premiums increased double, triple — in some states they're going to quadruple."

"You can argue that they were just for COVID," Gillespie said. "But I look at it as, it was one more step into making sure we have coverage for everybody in the country and taking it away now after people have become dependent on it is really a cruel blow to people that are facing price increases from inflation."

State-based exchange

Before Gov. JB Pritzker named Gillespie to lead the Insurance Department in 2024, she served in the state Senate and was the lead sponsor of the 2023 legislation that called for setting up a state-based exchange. Before that, Illinois residents had to use the federal portal, HealthCare.gov, to enroll in ACA insurance.

Gillespie said that bill came about in response to federal policy changes during the first Trump administration, which included shortening the open enrollment period and reducing funding for employing "navigators" who helped people find coverage plans to suit their needs.

"The value of a state-based exchange is that you've got some independence from the federal administration changes and the policy shifts," she said. "So, as a state-based exchange, you've got a little more ability to customize the plan offerings for the residents of your state. You have a little more leeway with setting special enrollment periods."

Gillespie said starting in 2026, there will be two additional enrollment opportunities under the state-based exchange.

One will be a pregnancy open enrollment, she said, "so if you find out that you're pregnant in between open enrollments, we can have a special enrollment period so you can get coverage."

A second opportunity will be tied to filing individual tax returns. "There will be a space on your tax return where you can check to indicate that you'd like enrollment materials for the state-based market," she said.