OPEN ENROLLMENT THROUGH the state health care marketplace begins on November 1, and hundreds of thousands of people are staring down bracing changes to their health care costs. Notices are going out all across the Commonwealth warning residents about rising premiums if pandemic era tax credits are left to expire at the end of the year – the issue at the heart of the government shutdown. 

“We don’t have the luxury of planning for a hypothetical open enrollment, or the hope or the chance of open enrollment” that looks like prior years, said Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, on The Codcast. “We have to deal with the reality in front of us.” 

This week, on the monthly Health or Consequences episode of The Codcast, Gasteier joined John McDonough of the Harvard TH Chan School of Public Health and Paul Hattis of the Lown Institute to discuss the looming deadline.  

The average premium increase is expected to be $1,300 a year in the state if the tax credits are not extended, she said. 

“We know that those are going to be eye-popping notices for a lot of individuals,” she said. “We have done a lot of work to intensify and clarify those communications so people understand what’s happening, that they understand it’s a result of federal law and federal policymaking.” 

The idea of the Health Connector is that it’s a centralized marketplace where residents can access insurance coverage products that are vetted by the state. When the Biden administration passed the American Rescue Plan in 2021, it created enhanced premium tax credits to make the Affordable Care Act’s (ACA) low-income subsidy for premiums more generous and removed an income cap that had created a cliff for moderate-income people who still needed help affording the care.  

This was “a game changer” that “turbocharged ACA enrollment all over the country,” Gasteier said. 

The credits were extended two years later, but have become a flashpoint this year between Democrats, who want to see them extended again, and Republicans who are still deeply critical of the ACA but without a clear alternative as frustration mounts from constituents over the credit loss.

If these tax credits are not extended, the consequences when the calendar flips to 2026 will be immense, Gasteier said.  

Massachusetts would lose about $425 million in federal support to make insurance more affordable. About 337,000 people in the Bay State would feel the impacts of higher premiums, Gasteieir said, and 26,000 of them would no longer get any tax credit at all. “If Congress doesn’t take action to extend these, that’s several hundred millions of dollars just evaporating out of thin air for Massachusetts residents to help afford their coverage,” she said. 

Massachusetts residents have a longer open enrollment period that runs through January 23, Gasteier noted, though part of the federal government recently finalized a rule that will remove that enrollment timeline flexibility starting next cycle.  

“I wouldn’t suggest to people that they wait,” she said. “If they want to come in and start exploring their plan choices and checking provider networks and the rest, they should do that. But they don’t actually have to pick a plan and make a payment to effectuate their coverage that starts January 1st until December 23rd. So there are several more weeks where, if things do change and subsidy eligibility changes or the rest, we will be in touch with people right away so that they know that.” 

On the episode, Gasteier talks about her long history with the Health Connector (1:05), who would feel the premiums increase most sharply (10:00), and how to parse White House talking points about the ACA’s effectiveness (17:20).