Duckworth, Durbin, Illinois Delegation Members Pen Letter to Health Insurance Companies, Seeking Answers About Cost of Republicans’ Inaction on Extending ACA Tax Credits

October 14, 2025

In their letters to eight health insurance companies, the lawmakers emphasize that Illinoisans rely on ACA enhanced premium tax credits to afford health care

 

[WASHINGTON, D.C.] – Today, U.S. Senator Tammy Duckworth (D-IL) and U.S. Senate Democratic Whip Dick Durbin (D-IL) led all Democratic members of the Illinois congressional delegation in sending a letter to health insurance companies to request answers about how the potential expiration of the Affordable Care Act enhanced premium tax credits would impact Illinoisans using the marketplace to purchase insurance. Today’s letter comes as the Republican-led government shutdown continues and Republican congressional leaders and President Trump refuse to extend the ACA tax credits that expire at the end of 2025. If these tax credits are not extended by the end of the year, more than four million Americans could lose their health coverage, and more than 20 million Americans are expected to see a significant rise in their premiums.

“We are writing to request information about how the potential expiration of the Affordable Care Act’s (ACA; P.L. 111-148) enhanced premium tax credits would impact patients, health care providers, and hospitals in Illinois,” the lawmakers began. “The ACA established premium tax credits, helping lower- and middle-income families lower their health insurance premiums for plans offered through the marketplace. These premium tax credits made health care affordable for millions of families, small business owners, and farmers across the country.”

In 2021, Democrats passed the American Rescue Plan, establishing these enhanced premium tax credits to support Americans in affording their health insurance. In 2022, Democrats passed the Inflation Reduction Act, extending these critical enhanced premium tax credits.

“To make health care even more affordable, the American Rescue Plan Act (P.L. 117-2) enhanced the premium tax credits. This measure ensured that eligible households would not contribute more than 8.5 percent of their income to their health insurance premiums and allowed more middle-income Americans to access the premium tax credits,” the lawmakers wrote.

“Due to the beneficial impact these enhanced tax credits had for American families, Congress extended them as part of the Inflation Reduction Act (P.L. 117-19) through the end of 2025. The enhanced premium tax credits helped double enrollment in ACA health plans from 11.4 million Americans in 2020 to 24.3 million Americans in 2025. In Illinois, ACA enrollment grew 59 percent, from 292,945 Illinoisans in 2020 to 465,985 in 2025. The enhanced premium tax credits have allowed more Americans to access primary care visits, prescription drugs, mental health and substance use disorder services, maternity care, and other essential health benefits,” the lawmakers wrote.

Continuing their letter, the lawmakers emphasized that if Republicans in Congress allow these enhanced premium tax credits to expire, premiums for more than 22 million Americans, including 395,850 Illinoisans will more than double—from an average of $888 to $1,904 each month. But some Americans could see even steeper premium increases.

“In Illinois, a 60-year-old couple with an income of $82,800 could see their annual premium increase $17,018—254 percent—while a family of four with an income of $64,000 could see their annual premium increase $2,571—226 percent. Such a large premium increase is unsustainable for most families. In fact, more than four million Americans will become uninsured due if Congress does not act, including 106,000 Illinoisans,” the lawmakers wrote.

The lawmakers underscored that health care providers and hospitals will lose critical revenue if Republicans allow the tax credits to lapse. The Robert Wood Johnson Foundation projects that hospitals and health care providers across the U.S. could lose more than $32 billion in revenue, while uncompensated care costs could increase by $7.7 billion, in 2026.

“For hospitals and providers in Illinois, lost revenue could amount to $372 million, while uncompensated care costs could increase by $129 million. This is in addition to the congressional Republicans’ $1 trillion Medicaid cut included in the One Big Beautiful Bill Act, which will reduce federal Medicaid funding to Illinois by 19 percent over the next decade. We worry that health care providers and hospitals will face even more severe financial hardship if the enhanced premium tax credits expire, and patients will suffer,” the lawmakers wrote.

Concluding their letter, the lawmakers requested details about the potential impacts of Republicans refusing to address this health care crisis.

The following insurance companies received a copy of the lawmakers’ letter: Blue Cross Blue Shield Association, UnitedHealthcare, Cigna Group, Molina Healthcare, Celtic Insurance Company, Mercyhealth, and Oscar Health Inc.

A copy of the letter is available here and below:

October 14, 2025

Dear [CEO],

We are writing to request information about how the potential expiration of the Affordable Care Act’s (ACA; P.L. 111-148) enhanced premium tax credits would impact patients, health care providers, and hospitals in Illinois.

The ACA established premium tax credits, helping lower- and middle-income families lower their health insurance premiums for plans offered through the marketplace. These premium tax credits made health care affordable for millions of families, small business owners, and farmers across the country. To make health care even more affordable, the American Rescue Plan Act (P.L. 117-2) enhanced the premium tax credits. This measure ensured that eligible households would not contribute more than 8.5 percent of their income to their health insurance premiums and allowed more middle-income Americans to access the premium tax credits.

Due to the beneficial impact these enhanced tax credits had for American families, Congress extended them as part of the Inflation Reduction Act (P.L. 117-19) through the end of 2025. The enhanced premium tax credits helped double enrollment in ACA health plans from 11.4 million Americans in 2020 to 24.3 million Americans in 2025. In Illinois, ACA enrollment grew 59 percent, from 292,945 Illinoisans in 2020 to 465,985 in 2025. The enhanced premium tax credits have allowed more Americans to access primary care visits, prescription drugs, mental health and substance use disorder services, maternity care, and other essential health benefits.

If the enhanced premium tax credits are not extended, premiums for more than 22 million Americans, including 395,850 Illinoisans, will more than double—from an average of $888 to $1,904 each month. Some could see even steeper increases. In Illinois, a 60-year-old couple with an income of $82,800 could see their annual premium increase $17,018—254 percent—while a family of four with an income of $64,000 could see their annual premium increase $2,571—226 percent. Such a large premium increase is unsustainable for most families. In fact, more than four million Americans will become uninsured due if Congress does not act, including 106,000 Illinoisans.

Health care providers and hospitals across Illinois also will be impacted if the enhanced premium tax credits are not extended by the end of the year. According to the Robert Wood Johnson Foundation, hospitals and health care providers across the United States could lose more than $32 billion in revenue, while uncompensated care costs could increase by $7.7 billion in 2026. For hospitals and providers in Illinois, lost revenue could amount to $372 million, while uncompensated care costs could increase by $129 million. This is in addition to the congressional Republicans’ $1 trillion Medicaid cut included in the One Big Beautiful Bill Act, which will reduce federal Medicaid funding to Illinois by 19 percent over the next decade. We worry that health care providers and hospitals will face even more severe financial hardship if the enhanced premium tax credits expire, and patients will suffer.

To help inform our legislative efforts to improve health care for Illinoisans and better understand the implications of letting the ACA tax credits expire, we request that [health insurer] respond to the following questions by October 22, 2025:

1. How many Illinoisans does [health insurer] cover? Please provide statewide figures and a breakdown by congressional district.
2. How many Illinoisans does [health insurer] cover who receive the enhanced premium tax credit? Please provide statewide figures and a breakdown by congressional district.
3. For Illinoisans who are covered by [health insurer] and receive the enhanced premium tax credit, what is their average premium reduction? Please provide statewide figures and a breakdown by congressional district.
4. If the enhanced premium tax credits are allowed to expire because of congressional Republican inaction, does [health insurer] plan to increase premiums for Illinoisans next year?
1. If so, please provide the justification for such premium increases.

2. If so, please provide the average statewide increase and a breakdown by congressional district.

5. If the enhanced premium tax credits are allowed to expire because of congressional Republican inaction, does [health insurer] expect the Illinoisans it covers to lose coverage?
1. If so, please provide estimated statewide coverage losses and a breakdown by congressional district.

2. If so, what continuity of care plans does [health insurer] have in place for Illinoisans?

6. When would notices of premium changes be sent to Illinoisans?
1. How many Illinoisans will [health insurer] have to notify?

2. How will [health insurer] inform Illinoisans (e.g., mail, e-mail)?

3. What processes does [health insurer] have in place to ensure that Illinoisans will be informed before their coverage is renewed?

7. If the enhanced premium tax credits expire, are there specific counties that will cease to be a part of [health insurer’s] service area?
1. If so, approximately when will such a decision to exit be made?

Thank you for your timely attention to this important issue.

Sincerely,

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