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State officials warn marketplace premium tax credits could sunset and raise premiums; regulators approved 2026 rate filings amid federal uncertainty
Summary
Oregon regulators told lawmakers that enhanced premium tax credits scheduled to expire could cause large increases in consumer premiums and that the Division of Financial Regulation finalized 2026 insurer rate approvals after federal regulatory uncertainty delayed the process.
State agency officials told the Interim Committee on Health Care that uncertainty over federal changes to marketplace premium tax credits could sharply raise what consumers pay even though the state'level rate approvals reflect underlying insurer rate requests.
Claire Pierce Grobel of the Oregon Health Authority told the committee that 111,000 marketplace enrollees benefit from enhanced premium tax credits enacted in 2021 and that if Congress allows those enhancements to lapse, some enrollees would see average monthly premium increases ranging from about $127 to $456 depending on income and plan. Grobel said older adults and residents in rural areas would likely face larger increases because of age rating and regional rate differences.
TK Keane, acting insurance commissioner and administrator of the Division of Financial Regulation, and Lily Sobelik, acting deputy administrator, explained Oregon's rate review process. Keane said the division approved 2026 final rates on Oct. 8 after an unusually delayed process caused by federal regulatory changes and litigation. The division, Keane said, reviews filings to ensure proposed rates are actuarially sound and that insurers have sufficient reserves to pay claims while seeking to protect consumers.
Sobelik and Keane said a primary driver of insurer rate filings this year was trend: rising costs per unit and higher utilization of services following pandemic disruptions and other market changes. Keane reported the individual market weighted'average increase approved for 2026 was just under 10%, while the small'group market weighted average was about 11.5%.
Committee members pressed regulators on whether rate approvals and the cost growth target'accountability regime produce conflicting incentives. Regulators said the two processes measure different things: the Division of Financial Regulation approves prospective premium rates based on insurer filings, while the cost growth target measures retrospective payer and provider spending (what payers actually pay out) with a different statutory purpose.
Panelists said the division will provide additional materials to the committee on drivers of utilization, mandated benefits added since 2017 and comparative trend data if members request it. Officials also noted that while approved rates set the amount insurers may charge, changes to federal financial assistance could materially change what consumers owe at the point of purchase.
