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Virginia exchange reports thousands of marketplace cancellations; tax‑credit expirations could leave 100,000 uninsured
Summary
Virginia’s insurance exchange told the Health and Human Services Committee that expiration of expanded federal premium tax credits and HR1 changes affecting immigrants have already driven enrollment declines; the exchange estimated as many as 100,000 Virginians could lose coverage if federal policy does not change.
Kevin Patchet, director of the Virginia Health Benefit Exchange, told the House Health and Human Services Committee that the expiration of expanded federal premium tax credits and recent HR1 provisions have already produced measurable drops in marketplace enrollment and that the exchange expects further declines.
Patchet said the exchange saw about 14,000 fewer enrollees so far compared with the same point last year and that terminations and customer‑driven cancellations have roughly doubled. He warned that the full effect of payment grace periods and subsequent disenrollments may not show up until April and estimated that, overall, as many as 100,000 Virginia residents could become uninsured as a result of combined federal policy changes.
"We may lose up to 100,000 Virginiaians or 100,000 Virginiaians will go without health insurance," Patchet said, adding that about 80,000 people are most directly exposed to the expiration of enhanced premium tax credits and that roughly 19,000 lower‑income lawful immigrants lost tax‑credit eligibility because of HR1 changes that removed a prior eligibility pathway.
Patchet explained how premium tax credits work (advanceable federal tax credits that lower monthly premiums based on income) and that the credits expanded in 2021 have now expired. He told the committee the exchange estimates roughly $260 million per year in lost premium tax credit assistance tied to the expirations for the mid‑range market and an additional roughly $120 million connected to HR1's effects on those under 100% of the federal poverty level.
Delegates asked whether cancellations were consumer‑driven or carrier‑initiated; Patchet said most terminations observed this open‑enrollment period are consumer‑driven and that the exchange’s effectuation rate (first premium payments) is down by about 6% compared to last year. He said the exchange collects termination reason codes but that detailed analysis of those codes is still pending because the system tracks many categories and the work to parse them is ongoing.
Patchet said the exchange is preparing contingency plans in case Congress restores expanded credits and is considering outreach extensions and marketing to recover people who walk away from coverage, but he warned that people who disengage are harder to re‑reach and that districts with large lower‑income populations could be disproportionately affected.
Patchet and the committee agreed to follow up on district‑level enrollment data and requests for more detailed actuarial cost estimates for potential state actions to backfill lost federal credits.
