Pennsylvania health insurance advocates warn ACA premiums will spike in 2026 if Congress lets tax credits expire

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Nearly half a million Pennsylvanians now have health insurance through Pennie, Pennsylvania’s Affordable Care Act marketplace — reaching a record high for this year’s open enrollment, state officials report.

Officials credit much of this increase to enhanced tax credits that lower monthly premium costs. First introduced in 2021, these expanded subsidies have allowed some consumers to save an additional $100 or more each month while also extending financial help to individuals who previously earned too much to qualify.

However, these enhanced tax credits are set to expire at the end of this year unless Congress approves additional funding. Without additional funding, many Pennsylvanians could face difficult financial choices in 2026, according to advocacy groups.

“It’s half a million Pennsylvanians that risk seeing significant premium increases, having to make those tough decisions about whether coverage can still fit in their ever-stretched budgets and really making those hard choices about what they can continue to afford,” said Devon Trolley, executive director of Pennie.

Leaders from the state Insurance Department, Pennie and organizations like the Pennsylvania Health Access Network (PHAN) and Protect Our Care Pennsylvania are urging the new Republican-led Congress to allocate more funding and continue the subsidies, although some experts believe an extension is unlikely.

State officials estimate that without these subsidies, Pennie customers across the commonwealth could see an average premium increase of 82%. The exact amount would vary based on county and income level.

For example, a 60-year-old couple in Philadelphia earning $80,000 a year currently pays about $581 per month in insurance premiums after tax credits. Without them, their monthly premium would jump to $1,544. Similarly, a couple in York County could see premiums climb from $586 to $2,976, according to estimates by Pennie and the Pennsylvania Insurance Department.

If premium costs and prices significantly rise, experts worry that some people will drop health insurance altogether, joining an estimated 677,600 people in Pennsylvania who are already uninsured.

“If a lot of people drop out, what that typically looks like is the healthier people drop first,” Trolley said. “When [insurers] are only covering sicker people, what does that do to costs? It increases [premium] rates, so that makes coverage more expensive for everybody.”

Some Pennsylvanians like Adam Feine say they may need to switch to cheaper plans that offer less coverage. Feine, a real estate agent in West Chester, gets health insurance through Pennie for himself, his wife and their three young children.

With all his current tax credits, the family saves about $200 a month on premium costs, a significant amount for a one-income household.

But without some or all of that money, Feine said they worry about their options for next year.

“To have to say we need to get a health insurance plan that’s $200, $300, $400 less a month means that potentially my kids wouldn’t be able to go to their pediatrician that we have in place right now,” he said. “And that’s just a decision that we hope that we’re not faced with.”

In Pittsburgh, small business owner Victoria Baggot is also bracing for the potential loss of enhanced tax credits. Right now, she pays about $197 per month, but without the subsidies, her premiums could rise by about $200 monthly.

“The financial burden of paying for the health care that I need would involve a second job, pushing back or rethinking starting a family and possibly not being able to afford care that keeps me healthy as a person with chronic illness,” Baggot said.

Those who switch to cheaper, but less comprehensive, plans often face higher deductibles and copays. According to Antoinette Kraus, executive director of PHAN, that could lead people to avoid care or end up with unpaid medical bills.

“We need action quickly to make this [subsidy] program permanent,” Kraus said, “and take the fear and uncertainty out of health care costs and not go backwards to a time where we’re seeing high uninsured numbers and even more folks struggling with the cost of care and eventually leading to medical debt or conditions that could have been treated sooner.”

Pennie, state officials and health advocates continue to urge Congress to act before the enhanced tax credits expire, underscoring the impact these subsidies have on affordability and access to care in Pennsylvania.