As ACA tax credit debate continues in Congress, Illinois sees slight decrease in enrollment

Illinois is on track to have slightly fewer people enrolled in the Affordable Care Act marketplace this year following the expiration of enhanced tax subsidies that were at the center of last year’s federal government shutdown.

The 4% decrease in enrollment is, so far, less severe than what many experts and advocates had anticipated, especially since enrollees in Illinois were expected to see an average increase of 78% in their monthly premiums. Anywhere from 2 to 4 million people across the country were expected to become uninsured if the tax credits weren’t extended.

As of Jan. 4, Get Covered Illinois, the state-run marketplace, reported 445,335 Illinois residents had signed up for an Obamacare health insurance plan. People had to enroll in a plan by Dec. 31 so coverage could start by the first of the year, but enrollment is open through Jan. 15.

In 2025, a record 465,985 people across the state enrolled in the ACA, according to data from the Centers for Medicare & Medicaid Services.

Get Covered Illinois did not provide further comment on enrollment figures.

Kathy Waligora, deputy director of external affairs at the Chicago-based EverThrive Illinois, which advocates for health care reform, said she was encouraged that the enrollment decline was minimal and that so many people actively chose a plan for this year.

While almost half of those enrolled by Jan. 4 were automatically re-enrolled in a plan, another 38% renewed by actively making a plan selection, according to Get Covered Illinois. About 13% of enrollees are new to the marketplace.

“Illinois has done a great job in sort of deploying navigators and marketing and all of these different resources to reach folks across Illinois and the data shows that was effective,” Waligora said.

Waligora said she worries about the people who were automatically enrolled in their plan, saying it’s unclear if individuals will be prepared to pay the likely higher monthly premiums.

Waligora said more data — such as how many individuals will get financial assistance for this year and what that looks like by region — is needed to assess the full impact of the expiration of the tax credits. She remained hopeful that there could still be a chance for the subsidies to be reinstated and extended for the coming years.

“I think that this should have been done in June, not September, not October, certainly not January,” Waligora said. “But it is good to see progress on this issue, and I sincerely hope that the Senate will take it up.”

This week, Republican lawmakers broke away from their leadership in the House and passed legislation to extend the subsidies, but the Senate isn’t required to take up the bill and has been working on an alternative plan, the Associated Press reported. Some Republicans have argued that Congress should consider a plan that would lower insurance costs for more Americans, not just those who use the marketplace.

Waligora is a leader in the Protect Our Care Illinois Coalition, which has been among the advocates pushing for the extension of the tax credits so plans could remain affordable. Many advocates worried people could become uninsured if they couldn’t afford the ACA plans.

In Illinois, about 85% of enrollees benefited from the subsidies, according to an analysis from KFF, a San Francisco-based health policy organization.

U.S. Rep. Raja Krishnamoorthi, who earlier this week visited the Cook County Health Bronzeville Health Center to talk about the tax credits, said any decline is concerning and cast blame on Republicans. Krishnamoorthi is a Democrat.

“Their failure has driven up costs and forced families across Illinois to reconsider or lose coverage,” he said Friday in a statement.

The enhanced tax credits date back to the COVID-19 pandemic when they were used to make the ACA plans more affordable by offering deeper levels of financial assistance and offering reduced benefits to middle-class enrollees that phase out as a person’s income rises.

Those subsidies had continued until they expired at the end of last year. Democrats wanted them extended but Congress was unable to come up with a resolution.

Last year, there was a 17% increase in enrollment in Illinois compared to 2024, mirroring a national trend of more people turning to the ACA for health insurance.

Across the country, there were 24.3 million people getting health insurance through the ACA, an increase from the 11.4 million people who were enrolled in 2020, according to federal data.

This year was the first time Illinois residents enrolled in Obamacare through a state-run marketplace.