‘Something’s got to give’: Sticker shock hits suburban Affordable Care Act enrollees

Since November, a steady stream of clients have been walking into the DuPage Health Coalition’s Carol Stream offices clutching tax forms and other documents.

Many walk out facing “sticker shock and some really difficult decisions,” DHC President Kara Murphy said.

Seismic rate hikes are stressing millions of Americans, particularly people insured through the Affordable Care Act, also known as Obamacare. That includes about 550,000 residents of Illinois.

DuPage Health Coalition navigator Aisha Zafar helps individuals pick the right ACA plan. That’s complicated in the best of times but even more fraught this fall.

Zafar described a client who is diabetic and suffered two strokes. “He had an $80 a month plan … it went up to $400. He kept it because he has to have his ongoing care,” she said.

Two forces are causing the crisis — the first is the expiration of pandemic-era enhanced tax credits on ACA premiums, which help low- and medium-income households offset insurance costs. Unless Congress extends the subsidies, they’ll end at midnight Dec. 31.

The second is a spike in premiums resulting from people opting out of unaffordable ACA coverage, rising hospital and drug costs, inflation and other factors, according to health-care policy analysts at KFF.

Those “who stay in the pool are the people who have higher health care costs and higher expenses, which ultimately means that it’s more expensive for every single person enrolled,” Murphy said.

Enrollees in Get Covered Illinois, the state’s ACA health insurance marketplace, face an average premium increase of 78%, the Illinois Department of Insurance projects.

The average cost for Illinois households is $260 a month now and will increase to $464 next year.

The agency expects net ACA premiums will rise in 2026 by an average of 95% in Cook County, 71% in DuPage, 66% in Kane, 47% in Lake, 73% in McHenry and 83% in Will.

Besides navigators offering guidance on picking the right plan, the nonprofit DuPage Health Coalition provides up to $150 a month in subsidies to qualifying individuals enrolling in the ACA marketplace through their Silver Access program.

But the dramatic insurance spike is causing some people to give up, Murphy said, citing a woman whose insurance cost rose from $146 to $486 a month.

“Her enhanced premium tax credit she used to get was $297 and it went down to $149. She decided to stay uninsured. She couldn’t pay for it, even after our help,” Murphy said.

Typically, rates go up by 3% to 5% annually, Silver Access Program Manager Vanessa Corpus said. This year, “they’ve more than doubled.”

Adding to the angst are nuanced changes that can mean paying hundreds of dollars more in deductibles, medication co-pays and for tests, such as MRIs.

Coalition client Kimberly, who did not want her last name used, is facing a $500 monthly increase and “the coverage is horrible,” she said. Her 2026 plan set the maximum out of pocket at $19,000 instead of $7,500 and requires a 10% co-pay for prescriptions instead of a dollar amount. “What if a drug costs $5,000?” the Wheaton resident asked.

“Something’s got to give. Our health system is broken,” she added.

With all the variables, wading through plans with clients can take up to three hours instead of one, Murphy noted.

Nephtali Santiago and his wife, Norma, brought a brimming file folder to a Dec. 3 session with DHC navigator Luz Ramirez.

“Without their help we would be lost,” Nephtali Santiago said. The Addison couple’s biggest worry? Finding their doctors won’t be included in their new plan, the couple said.

What are ‘enhanced premium tax credits?’

The ACA originally provided tax credits on premiums for people whose incomes were up to 400% of the federal poverty level. The 2025 poverty level is $15,650 for an individual or $ 32,150 for a family of four.

Enhanced tax credits were introduced in 2021 for individuals with incomes above 400% percent of poverty levels, resulting in Obamacare participation jumping from 11 million to 24 million.

If enhanced subsidies end in 2026, KFF expects the harshest impact will fall on enrollees with the highest premiums, ones who are older and those in higher-premium locales. “Among enrollees with incomes over 400% of poverty, just over half are between ages 50 and 64,” KFF said.

While Senate Democrats pushed for an extension, Republicans proposed health savings accounts for ACA enrollees, but both measures failed Thursday. The House has yet to act.

“We are running out of time,” Murphy said.

· Do you have an ACA-related question or story? Drop an email to mpyke@dailyherald.com.