Lowering Marketplace Premiums, Increasing Transparency, and Making Health Coverage More Affordable

WHEREAS, affordability remains my top health care priority as Governor, and I am committed to ensuring that Rhode Islanders are not priced out of health insurance coverage due to rising premiums;

WHEREAS, Rhode Island has a responsibility to maximize the value of federal affordability programs and to take all reasonable administrative steps to ensure that marketplace enrollees can access predictable, affordable monthly premiums, especially at a time when the cost of living is top of mind for families across the state;

WHEREAS, HealthSource RI (HSRI) has established and operates Rhode Island's state-based insurance marketplace, creating an efficient platform through which Rhode Islanders can purchase health coverage for themselves and their families and access federal premium tax credits;

WHEREAS, the Office of the Health Insurance Commissioner (OHIC) holds statutory authority to review and approve insurer rate filings, to ensure marketplace premiums are justified, actuarially sound, and aligned with the state's goal of affordability and access;

WHEREAS, coordination between HSRI and OHIC is essential to ensure that any adjustments to marketplace plan design, premium structures, or federal tax credit opportunities are implemented in a timely and consumer-protective manner;

WHEREAS, the enhanced portion of federal advance premium tax credits provided by the American Rescue Plan Act and later extended by the Inflation Reduction Act expired on December 31, 2025 resulting in steep net premium increases for most enrollees who purchase their health insurance through HSRI;

WHEREAS, additional restrictions and burdens placed on the individual marketplace through the enactment of the One Big Beautiful Bill Act (H.R. 1) have increased the urgency for state action to preserve affordability and coverage stability;

WHEREAS, 88% of Rhode Islanders enrolled in the individual market receive federal premium assistance to help afford health coverage;

WHEREAS, the decision by the Trump Administration to end federal reimbursements for cost-sharing reduction (CSR) subsidies disrupted the individual market and forced states to adopt new strategies-such as silver loading-to protect consumers from resulting premium increases;

WHEREAS, adopting measures similar to those used by other states to maximize federal financial assistance funding could result in meaningful reductions in monthly premiums for more than 20,000 Rhode Islanders;

WHEREAS, the lack of transparent, accessible information about the cost of common health care services leaves patients unable to compare prices, plan for out-of-pocket expenses, or make informed decisions about where to seek care-despite wide variation in costs across providers and settings; and

WHEREAS, the General Assembly's FY 2026 budget imposed a new health insurance premium fee applied to every covered Rhode Island family, a measure inconsistent with my administration's commitment to affordability and one of the reasons I declined to sign the budget.

NOW, THEREFORE, I, DANIEL J. McKEE, by virtue of the authority vested in me as Governor of the State of Rhode Island, do hereby order as follows:

1. OHIC and HSRI shall coordinate to ensure that any premium adjustments related to CSR loading are implemented in an actuarially sound manner that maximizes federal premium tax credits and lowers premium costs for individual market enrollees in Rhode Island.
   
   1. Through the rate review process, OHIC shall require all insurers offering individual market plans to be available through HSRI to apply an OHIC-defined methodology for pricing CSRs into silver tier plan rates in each rate filing. OHIC shall issue guidance and perform oversight to ensure there is actuarial justification for the approach and that it is implemented in a manner that promotes affordability for non-silver plan enrollees.
   2. HSRI, in consultation with OHIC, shall develop and disseminate clear consumer-facing materials to explain federal tax credit eligibility, plan costs-such as premium, deductible, and out-of-pocket expenses-and net premiums once federal tax credits are taken into account.
2. OHIC shall, by October 31, 2026, design, develop, and launch a public-facing health care price transparency dashboard that provides Rhode Islanders with accessible, reliable information on the cost of common health care services across providers and settings. The dashboard shall:
   
   1. Present clearly organized and searchable data on negotiated prices and average allowed amounts for a range of shoppable, high-variation services such as imaging, labs, and outpatient procedures;
   2. Leverage existing insurer-reported data through the all-payer claims database and any additional reporting authority available to OHIC under state law;
   3. Be maintained and updated regularly, with clear methodology and documentation to ensure credibility, usability, and sustained impact on market behavior.
3. OHIC and EOHHS shall evaluate opportunities to promote or implement site-neutral reimbursement and transparency across commercial and Medicaid markets and shall report to the Governor by October 31, 2026 with recommended administrative, regulatory, and statutory actions to reduce cost variation and support value-based purchasing. This review shall include options to prohibit or limit the use of facility fees, particularly for outpatient and off-campus services, where such fees contribute to unwarranted cost differentials without corresponding differences in clinical complexity or quality.
4. OHIC shall conduct a comprehensive review of state-imposed health insurance mandates and quantify their contribution to premium levels and premium growth in the individual and group markets. This review shall include actuarial analysis where appropriate and identify opportunities to improve transparency, affordability, and alignment with essential health needs. Findings shall be submitted to the Governor by December 31, 2026.

This Order shall take effect immediately upon the date hereof.

So Ordered:

Daniel J. McKee
Governor