Kayley Spencer is not unemployed, nor is she reduced to irregular independent contractor work.\u00a0<\/p>\n
In fact, Spencer is the executive director of a nonprofit child care center in Duluth, Lakeside Early Learning, where she supervises 14 full-time and 15 part-time staff.\u00a0<\/p>\n
Still, Spencer cannot afford health insurance, either for herself or her employees.<\/p>\n
\u201cChild care operates at razor thin margins,\u201d Spencer said.<\/p>\n
Spencer thought this year might be different. Then she shopped for insurance<\/a> through MNsure, the marketplace that stemmed out of the Affordable Care Act and is run as an independent state agency.\u00a0<\/p>\n \u201cI was really open to any plan. I was all the way through the application process, filtering out for the most affordable. But they were all too much.\u201d<\/p>\n When the enrollment period opened Nov. 1, MNsure officials warned<\/a> that enrollees\u2019 monthly premiums would soar 57% due to the expiration of a federal subsidy, among other cost factors.\u00a0<\/p>\n Enrollment closed Jan. 15, and, according to MNsure, 139,251 Minnesotans signed up, an 8% drop compared with 2025.\u00a0<\/p>\n Given the eye-popping increase in monthly premiums, this 8% dip seems modest.<\/p>\n But the decline does not account for tens of thousands Minnesotans who signed up for a less encompassing plan. Plus, it is too early to know how many people will lose coverage for not making premium payments.\u00a0<\/p>\n \u201cWhat I suspect and fear is that as we get further into the year, the number of Minnesotans who do not have coverage will climb,\u201d said Libby Caulum, CEO for MNsure.<\/p>\n State Rep. Erin Koegel, DFL-Spring Lake, will convene<\/a> the Minnesota House Commerce Finance and Policy Committee Wednesday to look at the future of MNsure.<\/p>\n Here is an early glimpse of how MNsure enrollment is changing.\u00a0<\/p>\n Why did people opt out of MNsure?<\/p>\n To review, people are on the 12-year-old MNsure program because they do not get health insurance from their employer.\u00a0<\/p>\n They also make too much to qualify for the state\u2019s Medicaid program, or MinnesotaCare, which offers health plans to residents who make less than 200% of the federal poverty level.<\/p>\n For example, Spencer (and her employees) make too much in yearly income to qualify for Medicaid or MinnesotaCare, making a plan through MNsure their most apparent choice for health care.<\/p>\n (If they so desire, individuals can directly negotiate with insurers to get a health insurance plan instead of buying one on the exchange.)<\/p>\n MNsure does have two subsidies of its own. One is a state fund called Reinsurance, which uses taxpayer money to cover pricey claims MNsure enrollees file with their insurer.\u00a0<\/p>\n Another is a federal advanced premium tax credit, which has been around since the start of the Affordable Care Act as a carrot for people to buy insurance.<\/p>\n However, a third subsidy<\/a>, the federal enhanced premium tax credit that started in 2021, sunsetted at the end of 2025.\u00a0<\/p>\n Related: Inside the nightmare winter for Minnesota child care providers<\/a><\/p>\n The record-length federal shutdown<\/a> in the fall was due to Democrats (and some Republicans) demanding an extension of the enhanced premium tax credit. But Congress reached a compromise that axed the subsidy extension.\u00a0<\/p>\n \u201cBecause Congress allowed the enhanced savings to expire, we heard from many consumers who felt priced out of the marketplace,\u201d Caulum said.\u00a0<\/p>\n The cheapest plans Spencer found were Bronze packages with $350 monthly premiums. Between running her nonprofit and paying for rent, Spencer said that health care needed to be squeezed.\u00a0<\/p>\n At age 29, Spencer said that she is in good health and is \u201cjust hoping illnesses pass.\u201d<\/p>\n Traditionally, MNsure, and insurers on the exchange such as Blue Cross Blue Shield and Medica, rely on young, healthy enrollees like Spencer to help pay for those who use health care more.\u00a0<\/p>\n \u201cWhen people make the really difficult decision to go without insurance, it has implications for the whole health system,\u201d Caulum said.\u00a0<\/p>\n Who decided to stay on MNsure?<\/p>\n Beki Cook has a condition called hereditary angioedema in which her tongue can swell to the point where she can\u2019t breathe.\u00a0<\/p>\n In 2025, she paid $1,000-a-month for a plan she bought for herself and her twin sons that covered a drug for her condition, called Orladeyo.\u00a0<\/p>\n Had Cook stayed in the same plan for 2026, it would have cost her $1,400-a-month. She switched to a plan that costs $1,200 a month.<\/p>\n However, Cook\u2019s doctor advised her to go on a different medicine, Takhzyro, because Orladeyo \u201cwasn\u2019t working as the doctor hoped, but now I can\u2019t get the new medication covered,\u201d she texted.\u00a0<\/p>\n Cook said that she is currently going through an appeals process with her insurer.<\/p>\n All told, 25,931 enrollees switched plans for 2026, according to MNsure, an 87% leap in the number of people who changed plans compared with 2025.\u00a0<\/p>\n