Providence resident Daniella Stark currently pays $45 a month for her health care coverage. But with the enhanced COVID-19-era Affordable Care Act subsidies set to expire at the end of the year, Stark is preparing to pay $217 a month — over four times her current rate.
“It was this massive shock,” Stark told The Herald. She initially expected prices to double, which would put her total monthly costs at about $100, close to what she paid before the pandemic.
With rising costs expected to hit millions of Americans, the White House has circulated a proposal to extend these subsidies by two years, but the plans are not yet final.
The ACA — also known as Obamacare — provided federally subsidized health care to 48,166 Rhode Island residents in 2025. During the COVID-19 pandemic, the federal government designated about $60 million annually to help R.I. families stay insured and expand eligibility.
Former President Joe Biden used the Inflation Reduction Act of 2022 to extend these subsidies through Dec. 31 of this year.
If the subsidies do expire at the end of the year, HealthSource RI — the state’s primary ACA marketplace — estimates that 13,100 Rhode Islanders will lose coverage, and those who retain their health care will pay double their previous amount on average, according to John Cucco ’09, the chief of staff of HealthSource RI.
Stark shared that her household income amounts to about $60,000 annually, below the R.I. median household income of $92,290 but still in the upper third of ACA recipients.
“My thought when I see these things is, ‘Okay, I can figure out how to manage this.’ Somebody one step below me on the ladder is freaking out,” she said. “It’s not tenable.”
The expiration of ACA credits are expected to reduce HealthSource’s customers from 48,000 to 27,004 by 2030, according to documents shared by the marketplace, which details an expected loss of $70 million per year as those customers stop paying for their health care.
Shamus Durac — a senior attorney and health policy analyst at the Rhode Island Parent Information Network and co-chair of Protect Our Healthcare R.I. — explained that the original ACA subsidies, established in 2014, were not equipped to deal with rising health-care costs nationwide.
Back in September, Blue Cross Blue Shield R.I. — the largest health insurer in the state — received approval from the R.I. Health Insurance Commissioner to increase their individual rates by 22% in 2026.
“The underlying coverage was not as expensive, but now it is,” Durac said. “I think that it’s incredibly important that the government act to protect these safeguards in place.”
BCBSRI did not respond to requests for comment.
Regardless of whether benefits expire, ACA marketplaces will also be forced to shorten their enrollment period, increase their documentation requirements and stop offering health care to some low-income immigrants who reside in the country legally, Cucco added.
Durac believes the best possible scenario is for the federal government to continue the enhanced subsidies, as they are the only ones with sufficient financial resources. Last year, Protect Our Healthcare R.I. lobbied the R.I. Legislature to create a replacement premium assistance program, but the state’s deficit and the potential for a federal extension — separate from the White House’s recently circulated plans — prevented the bill from passing, he added.
The Herald spoke to Durac prior to the White House sharing plans to extend ACA benefits.
He added that most of the funding created by the benefits went directly into the state’s struggling health care delivery system. Rhode Island’s hospitals — already dealing with CharterCARE’s delayed sale of their two R.I. hospitals, some of the highest bed occupancy rates in the nation and a primary care shortage — “cannot afford to lose” those funds, he said.
In the meantime, residents continue to worry. Stark’s husband was diagnosed with a chronic medical condition in 2017, and she is concerned that higher costs could create “life or death” situations.
“I’m going to cross my fingers,” Stark said. “Rhode Island does some amazing things and has made some really good decisions for its citizens, but we only have so much money.”
Clarification: This article has been updated to clarify that ACA marketplaces will be forced to shorten enrollment periods, increase documentation requirements and stop offering care to some immigrants, whether or not COVID-19 subsidies expire.
