Illinois takes over health insurance marketplace in 2026 amid skepticism
[August 18, 2025]
By Catrina Barker | The Center Square contributor
(The Center Square) – Illinois will fully take over operation of its
health insurance marketplace in 2026, moving away from the federal
Healthcare.gov platform and rebranding as the state-run Get Covered
Illinois exchange.
Gov. J.B. Pritzker said the shift will give the state more flexibility
to tailor coverage options to residents’ needs.
“Today marks a pivotal step towards bringing quality, affordable
healthcare to all Illinoisans,” Pritzker said.
In announcing the Centers for Medicare and Medicaid Services approving
Illinois’ transition to a state-based health insurance marketplace, the
governor’s office said beginning Nov. 1, Illinoisans who were previously
enrolled through Healthcare.gov will transition to Get Covered Illinois
for their 2026 coverage.
State Rep. Bill Hauter, R-Morton, a physician, said he gave the
legislation creating the marketplace “a lot of thought” before
ultimately voting for it a few years ago, but he remains skeptical.
“We were told that Illinois could do it better. But what has Illinois
done that’s gotten better or done better?” Hauter said. “In the end, I
think there is a chance that it could make it more streamlined and maybe
save some money. We’ll see.”
One concern Hauter raised is that Illinois’ political clashes with
Washington could affect federal funding and benefits.
“It’s a huge concern. Is the state going to use the marketplace to get
health insurance for illegal immigrants? The federal government could
respond by cutting other benefits to Illinois, maybe even Medicaid,”
Hauter said. “We have to ask ourselves: does Illinois really want to
keep fighting with the federal government on everything, whether it’s
[diversity, equity and inclusion], sanctuary status or illegal immigrant
health care?”
Hauter said the state is picking a fight with “an 800-pound gorilla, and
the people who get hurt are Illinois residents.”
“For the Trump administration, it’s no skin off their back, but Governor
Pritzker seems to think these fights help him stand out for a
presidential run,” he said.
In a news release, Get Covered Illinois Director Morgan Winters noted
that recent federal policy changes, along with the expiration of
Enhanced Premium Tax Credits, could lead to “double-digit premium
increases for many” Illinoisans.
“Since 2021, the federal government has offered enhanced tax credits,
making health insurance cheaper for those enrolled in marketplace
coverage. While some tax credits will still be available for those who
qualify, the amount will be smaller, driving up insurance costs for
enrollees,” states a news release from Get Covered Illinois.
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Illinois uses Healthcare.gov, the federal website, for people who
buy their own health insurance instead of getting it through a job,
Medicare or Medicaid. In 2026, those people will use Illinois’
state-based website instead. The federal government will still
decide which insurance companies are approved to sell plans, but
Illinois will run the sign-up system and decide what benefits the
plans must cover.
When asked what was wrong with Healthcare.gov, Hauter, a physician,
said many doctors and hospitals stopped accepting plans from the
federal exchange because the reimbursement rates were too low.
“Insurance products were terrible for providers, so much so that it
was almost like Medicaid reimbursement,” Hauter said. “When you get
reimbursed less than what it costs you to have the labor and the
overhead, you just cannot continue to stay in business. Even if more
people get covered, they might have struggled to find a doctor who
would take their insurance.”
Hauter said the state-controlled website likely isn’t going to be
much better for providers.
“I’m not here to look out for doctors or hospitals, but this new
state-run website isn’t being promoted as better for providers. It’s
advertised as easier for people who need insurance outside of their
job, Medicaid or Medicare,” said Hauter. “I ended up voting for it
because I want people to be able to go to a centralized marketplace
with experienced, knowledgeable people who can help them choose
insurance to protect themselves and their families. I want that to
happen, but that’s a good theory. I don’t know if it will work in
practice.”
State officials say the new system will have a simpler website, a
call center and more local “navigators” to help people sign up for
coverage.
Last year, as part of the transition to a state-based marketplace,
Get Covered Illinois launched a $6.5 million grant to establish a
statewide navigator network. These navigators are placed in
communities across Illinois and are trained to assist residents who
may need help applying for and enrolling in health insurance.
Open enrollment for 2026 coverage starts Nov. 1, 2025. Details are
available at GetCoveredIllinois.gov.
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