How to convince more Rhode Islanders to get health insurance? Make it cheaper.

At a time when gas prices, energy bills and groceries are all increasing, Rhode Island officials have some good news to share: your health insurance premium could be going down.

That’s the case for 30,000 people expected to sign up or reenroll in the state health exchange during the 2027 open enrollment period, which began Sunday and runs through Jan. 31.

The discounts depend on income level, age and the type of health plan. But the result is shared wallet relief that HealthSource RI Director Lindsay Lang hopes will at least preserve the existing enrollment numbers.

“The importance of having health insurance is that it can help protect against one bad turn of luck turning into lasting financial damage,” Lang said at an Oct. 21 press conference to publicize the start of open enrollment.

It’s the same message Lang preaches every fall ahead of the annual open enrollment period. 

Yet 10,000 Rhode Islanders dropped out of the state health exchange during the three-month long 2026 open enrollment period, unable to afford the surging premiums resulting from expired federal discounts. And many of the 39,000 people who did sign up for HealthSource RI opted for cheaper bronze medal plans, which have lower premiums but less comprehensive coverage and very high deductibles.

Rhode Island was not alone; more than 23.1 million people dropped coverage in Affordable Care Act-created state marketplace plans in 2026 — the sharpest decline since its 2013 creation, according to KFF. 

At least 10 states created or reconfigured their own discount programs to replace the federal tax credits for the 2026 open enrollment period, including Massachusetts and Connecticut. 

Rhode Island’s subsidy program does not begin until 2027, leaving thousands of Rhode Islanders on the lurch for 2026.

Consequences have already begun to ripple through the state’s fragile healthcare system. Commercial premiums are again poised to rise by double-digit percentages as insurers seek to recoup costs associated with covering a more limited and medically risky group of enrollees. Hospital systems, including Brown University Health, have seen a surge in debt and uncompensated care, prompting layoffs and deepening fears of future service cuts. 

“It’s probably been one of the most challenging years,” said Bunny Ssengooba, a navigator for Cranston-based social services agency Comprehensive Community Action Plan. “We had a lot of people who just kind of said, ‘we hope we don’t get sick.’”

Ssengooba has spent much of the last 10 months finding creative ways to help low-income families pay for medication and health services despite being un- or underinsured. 

Now, he is preparing to reach back out to the thousands of residents who dropped out of the health exchange to persuade them to come back. He’s making phone calls and showing up to community festivals and food pantries with information about the new and improved affordability measures.

He knows it won’t be easy.

“It’s a lot faster for people to walk away and not get enrolled,” he said. “It’s much harder to get them back.”

It’s a challenge with personal stakes for Ssengooba.

At 46, he’s had 16 surgeries in the last seven years, including a kidney transplant, because of complications from  high blood pressure that went undetected and untreated for years because he did not have health insurance.

Now healthy, insured, and married to a doctor, the East Providence resident is intent on making sure others avoid his fate.

“I tell people, ‘your life depends on it,’” he said.

Filling the gap 

One thing working in his favor: thousands of state and federal dollars that officials have leveraged to replace lost federal discounts for plan participants across a wide range of circumstances.

Gov. Dan McKee pushed for a $9.5 million carveout in his fiscal 2027 budget proposal to help offset the expired federal tax credits, which Congress chose not to renew beyond 2025. State lawmakers agreed to McKee’s proposal, adding on another $10 million earmark to carry the state funding through the 2027 calendar year.

The $19.5 million Rhode Island Marketplace Affordability Program is expected to reduce premiums for 20,000 current, former, and future HealthSource RI customers at both ends of the income spectrum.

For people whose earnings fall below 200% of the federal poverty level — $31,920 for one person or $66,000 for a family of four — the state will return average premiums to the prices people paid before federal tax credits expired, according to HealthSource RI. For enrollees whose earnings are above 400% of the federal poverty level — $63,840 for one person or $132,000 for a family of four — state funds will partially replace lost federal tax credits.

There’s money on the table for those in the middle, too. A separate state initiative born out of a March 12 executive order aims to maximize federal tax credits by manipulating the funding formula based on silver medal plan premiums, a strategy known as silver loading. At the time McKee signed the executive order, officials hoped to bring in $12 million more in federal funding to defray premium costs.

The exact funding boost will depend on enrollment, Lang said, but the formula fix already completed is expected to help another 10,000 people who fall between 200% to 400% of the federal poverty level, saving an average of $110 per person per month over current premiums.

Lang acknowledged the state’s investments and formula-maxing strategy are not a panacea for healthcare access and cost concerns.  

“This is one piece of an enormous puzzle given the shift from the federal level to the state level,” she said in an interview. “The proof will be in the pudding now as we try to connect customers to this new help.”

Initial calls to HealthSource RI’s East Providence contact center ahead of the Nov. 1 open enrollment start were tepid, though Lang expects it will pick up after Thanksgiving, as key deadlines in reenrollment or new enrollment approach

A targeted marketing campaign that includes text messages, emails and phone calls, along with online and traditional advertising, has already begun. Meanwhile, a network of 100 navigators across partner community agencies, including Ssengooba, are filling their calendars with appointments and outreach events to connect with prospective plan participants in their communities.

As of Oct. 30, Ssengooba has already booked three weeks of appointments, representing 60 to 70 potential people or households interested in learning more about — and maybe signing up for — HealthSource RI.

“I’ve kind of put everything else on hold,” Ssengooba said. “This is too important.”

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Courtesy of Rhode Island Current