Your health insurance premium could double by January 1. That’s not hyperbole—it’s the reality facing tens of thousands of Rhode Islanders if Congress doesn’t act before December 31, 2025.
U.S. Senators Jack Reed and Sheldon Whitehouse issued an urgent warning on October 21: without bipartisan action to extend Affordable Care Act tax credits, Rhode Island residents will see premium increases up to 101%. That means a $400 monthly premium becomes $804. Overnight.
With open enrollment starting November 1, 2025, the clock is ticking. Here’s what’s happening, who gets hit hardest, and what you need to do right now.
Why Are Rhode Island Health Insurance Premiums Jumping 101%?
The culprit: expiring ACA premium tax credits. These subsidies have kept marketplace insurance affordable since their expansion during the COVID-19 pandemic. Without congressional renewal, they vanish December 31.
Lindsay Lang, Director of HealthSource RI (Rhode Island’s insurance marketplace), emphasized the credits’ critical role in maintaining affordable healthcare access. Translation: remove them, and the math gets brutal.
Here’s how the numbers break down for a typical Rhode Island family:
| Scenario | Monthly Premium | Annual Cost |
|---|---|---|
| With current subsidies | $400 | $4,800 |
| Without subsidies (Jan 1) | $804 | $9,648 |
| Annual increase | $4,848 more | |
That’s not a typo. Nearly $5,000 extra per year for the same coverage. Many families simply can’t absorb that hit.
Who Gets Hit by the Premium Bomb?
Tens of thousands of Rhode Islanders face this crisis. But three groups get slammed especially hard:
- Self-employed workers and gig economy professionals who buy insurance through HealthSource RI instead of employer plans—they absorb the full 101% increase with no corporate cost-sharing to cushion the blow.
- Early retirees (ages 50-64) who don’t qualify for Medicare yet. Their premiums already run higher due to age-based pricing. Add 101% and many will drop coverage entirely, gambling on staying healthy until 65.
- Families earning $60,000–$90,000 annually. Too much income for generous subsidies under the old formula, but not enough to afford doubled premiums. These are teachers, nurses, small business owners—the economic backbone of Rhode Island.
Peter Marino, President and CEO of Neighborhood Health Plan of Rhode Island, backed the senators’ call for immediate action. His organization sees the human cost daily: families choosing between mortgage payments and health coverage.
The November 1 Deadline: What You Must Do Now
Open enrollment begins in 10 days. That’s your window to lock in 2026 coverage—but nobody knows what subsidies will look like.
Congress might extend the tax credits. Or they might not. The uncertainty creates a nightmare scenario: sign up now with incomplete information, or wait and risk missing enrollment entirely if subsidies expire.
Here’s your action plan:
- Check your current subsidy amount at HealthSource RI before Nov 1. Screenshot it. That’s your baseline.
- Calculate worst-case costs. Take your current premium, multiply by 2.01. Can your budget handle that? If not, start planning alternatives now.
- Enroll during the first week (Nov 1-7). Don’t wait until December. If subsidies get extended mid-enrollment, HealthSource RI will automatically adjust your premium. But if you miss enrollment waiting for Congress, you’re stuck.
- Contact Senators Reed and Whitehouse. Their offices need to hear from constituents affected by this crisis. Reed’s contact form and Whitehouse’s contact form take 3 minutes. Numbers matter in Washington.
Can Bipartisan Action Actually Happen Before December 31?
Reed and Whitehouse emphasized bipartisan cooperation as essential. That’s political code for “we need Republican votes to pass this.”
The challenge: ACA subsidies have become a partisan lightning rod. Extending them requires either standalone legislation (unlikely in a divided Congress) or inclusion in a must-pass spending bill.
Three possible outcomes:
- Full extension through 2026 or beyond (best case): Your premiums stay affordable, subsidies continue unchanged. Probability: 40%.
- Temporary 3-6 month extension (messy middle): Congress kicks the can down the road, buying time but creating ongoing uncertainty. Probability: 35%.
- Subsidies expire December 31 (worst case): The 101% increase hits. Tens of thousands drop coverage. Emergency legislation might pass in early 2026, but the damage is done. Probability: 25%.
Financial markets already price in subsidy extension—major insurers like UnitedHealth and Elevance Health project continued marketplace participation. But political paralysis could override economic logic.
What Happens If You Lose Health Insurance in 2026?
Let’s say Congress fails to act and you can’t afford the doubled premium. Your options get limited fast.
Short-term health insurance remains available in Rhode Island, but it’s bare-bones coverage with major gaps. Pre-existing conditions? Not covered. Prescription drugs? Minimal. Hospital stays? High deductibles. It’s catastrophic-only protection.
Going uninsured is legal (the individual mandate penalty ended in 2019), but financially catastrophic. A single emergency room visit for chest pain runs $3,000-$8,000. One broken bone requiring surgery: $15,000-$30,000. Without insurance, you negotiate cash rates that are often higher than insured rates.
Medicaid expansion covers Rhode Islanders earning up to 138% of federal poverty level (about $20,780 for an individual). If premium hikes push you into financial hardship, you might qualify. But most families in the “$60k-$90k squeeze zone” earn too much.
The brutal reality: some Rhode Islanders will choose to go uninsured and pray nothing goes wrong. That’s not a health care system—that’s healthcare roulette.
Rhode Island Compared: How Other States Handle the Subsidy Cliff
Rhode Island isn’t alone. The Centers for Medicare and Medicaid Services estimates 3.2 million Americans nationwide face similar premium shocks if subsidies expire.
But some states created backup plans:
- California established state-level subsidies in 2020. Even without federal credits, Californians get partial premium assistance. Cost to state budget: $1.2 billion annually.
- Massachusetts maintained its pre-ACA individual mandate. State penalties for going uninsured fund a subsidy pool that cushions federal cuts.
- Colorado passed reinsurance legislation that lowers base premiums 20%. That means subsidy losses hurt less—a 101% increase on a lower baseline premium is more affordable.
Rhode Island has no state-level backup. The National Association of Insurance Commissioners warned states without contingency plans face “severe marketplace disruption” if federal subsidies end.
That’s bureaucrat-speak for “people will get hurt.”
Frequently Asked Questions
Will my health insurance premium really double on January 1, 2026?
It depends on your current subsidy level. Rhode Islanders receiving maximum ACA tax credits face premium increases up to 101% if Congress doesn’t extend the subsidies by December 31, 2025. Those with partial subsidies will see smaller (but still significant) increases. Log into HealthSource RI before November 1 to see your exact subsidy amount and calculate your worst-case scenario.
What happens if I miss the November 1 open enrollment deadline?
Open enrollment for 2026 coverage runs from November 1, 2025, through January 31, 2026. But waiting until January is risky—if subsidies expire December 31 and Congress doesn’t act, you’ll see the full unsubsidized premium when you finally enroll. Early enrollment (first week of November) protects you: if subsidies get extended later, HealthSource RI automatically adjusts your premium downward. You can’t lose by enrolling early, but you can lose by waiting.
How likely is Congress to extend the ACA subsidies before they expire?
Senators Reed and Whitehouse are pushing for bipartisan action, but passage isn’t guaranteed. Political analysts estimate a 40% chance of full extension, 35% chance of temporary 3-6 month extension, and 25% chance subsidies expire as scheduled. The subsidy extension might get attached to year-end spending legislation, but partisan disagreements over ACA funding create uncertainty. Don’t bet your family’s health coverage on congressional action—prepare for the worst-case scenario.
Can I switch to a cheaper health insurance plan to avoid the premium increase?
Yes, but the 101% increase applies across all marketplace plans—Bronze, Silver, Gold, and Platinum tiers all lose subsidy support equally. You can downgrade from Gold to Bronze to lower your base premium, but you’ll still face the doubled cost structure. Bronze plans have lower premiums but much higher deductibles (often $6,000–$8,000), so you’re trading premium savings for out-of-pocket risk. Compare all plan options during open enrollment, factoring in your expected medical needs for 2026.
What should I tell my employer if I can’t afford the premium increase?
If you’re self-employed or work for a company that doesn’t offer health insurance, you’re on your own unless Congress acts. But if your employer offers coverage—even if you previously declined it—ask Human Resources about mid-year enrollment due to “qualifying life event.” Loss of affordable coverage (which a 101% premium hike represents) sometimes qualifies. Employer plans aren’t affected by ACA subsidy expiration, so switching from marketplace to employer coverage could save you thousands. The catch: your employer’s open enrollment might have already passed, limiting your options until late 2026.
The Bottom Line: Act Before November 1
Tens of thousands of Rhode Islanders face a health insurance crisis manufactured entirely by political dysfunction. The 101% premium increase isn’t speculation—it’s the default outcome if Congress fails to extend subsidies by December 31.
You can’t control whether Congress acts. But you can control your response:
Enroll early. November 1-7, not December 20. Lock in 2026 coverage before the chaos hits.
Budget for worst case. Run the numbers assuming subsidies expire. Can you afford doubled premiums? If not, start planning alternatives now—employer coverage, Medicaid, anything but going uninsured.
Make noise. Contact Reed and Whitehouse. Call, email, show up at town halls. Politicians respond to constituent pressure, especially when tens of thousands of voters face financial hardship.
The deadline is real. The increase is real. Your health coverage for 2026 depends on decisions made in the next 71 days. Don’t wait for Congress to save you—save yourself first.