Health Insurance Premiums See Significant Increases for Pennsylvania Families
Last year, Julia Tilley and her spouse managed to secure health insurance through the Marketplace. Tilley, who works in home health, provides care for her adult daughter with autism and a physical disability. Her husband, coping with a traumatic brain injury, is limited to part-time work.
This Harrisburg family, like over 20 million Americans, benefited from pandemic-related tax credit subsidies that have made healthcare more affordable. However, they’re now bracing for a sharp increase in insurance premiums, similar to the approximately 500,000 others in Pennsylvania enrolled in Penny, the state’s Affordable Care Act marketplace. Reports suggest an average hike of 102%.
For instance, a couple in York County aged 60, currently paying $7,032 annually, could see their costs soar to $35,712 under one scenario proposed by the state’s insurance department. While some attribute this spike to escalating medical and prescription drug costs, Tilley points to Congress’s inaction in renewing the premium credits that had eased the financial burden for many.
Republicans have labeled these tax credits as a pandemic-era encumbrance, seeking to eliminate them from the federal budget, whereas Democrats are pushing for expansions to safeguard vulnerable Americans amid rising living expenses and dwindling safety nets. This legislative deadlock has already culminated in a federal government shutdown.
As open enrollment kicks off, Tilley joins many others who fear that affordable health care may soon be a relic of the past. “I haven’t gotten the letter yet, so I’m unsure how much it will actually cost. It might be $1,200 a month,” she mentioned.
Many insurance providers are starting open enrollment, with nearly all expected to do so by November 1. Tilley remarked that her friends have begun receiving notifications, panic-stricken as one couple shared their monthly premium had skyrocketed from $100 to $1,800, well beyond their financial reach.
“There’s really no way to prepare for that,” Tilley expressed. “So, how do we suddenly come up with another $15,000 a year? My husband can’t work due to his head injury. I work full time, taking care of our daughter, and it’s not like I can just find another job. We’re kind of stuck.”
This past week, the Pennsylvania Department of Insurance addressed the steep premium hikes projected for 2026. “Pennsylvanians purchasing their own insurance will soon receive renewal letters from their insurers with shocking price increases,” said Insurance Commissioner Michael Humphries. He urged Congress to take action to protect families.
State officials indicate that premiums will rise for both individual consumers and small businesses, reflecting ongoing uncertainty at the federal level alongside increasing medical costs. Capital Blue Cross noted that these rising costs predominantly burden those purchasing insurance independently, stressing that significant premium hikes could result if the federal tax credit isn’t reinstated.
Offering coverage to around 50,000 Pennsylvanians, Capital Blue Cross shared that nearly 80% of their members rely on these subsidies. They emphasized the importance of collaboration among healthcare stakeholders to maintain affordability.
Antoinette Krause, executive director of the Pennsylvania Health Access Network, called the projected increases “staggering” and warned of their repercussions on families relying on Penny for health insurance. She elaborated that many enrollees, including gig workers and those in service industries, are already grappling with financial strain.
Advocates suggest that approximately half of Penny’s current enrollees may drop their coverage entirely, with many others likely forced into making tough decisions, such as opting for less comprehensive plans or delaying necessary medical visits. “For individuals battling conditions like cancer or diabetes, this can be a life-or-death situation,” Krause pointed out.
Mr. Tilley emphasized that this hike will impact everyone. “It’s not only those with insurance who will feel it; if people can’t afford health care coverage, the effects will ripple through society — from losing homes to being unable to buy food,” he said, warning that healthcare costs are likely to be the first thing many families cut back on.
Tilley has reached out multiple times to Rep. Scott Perry’s office without success. Recently, she also traveled to Washington, D.C., engaging with Democratic lawmakers advocating for the extension of the tax credit.
The local congressional district, represented by Perry, has about 32,000 residents enrolled in the ACA Marketplace, making up roughly 4% of the population. Reports indicate a significant portion of marketplace registrants reside in Republican-held districts, underscoring the bipartisan implications of these policies.
“This is a bipartisan issue,” Tilley stated. “It’s not just Democrats affected; it extends to everyone regardless of party affiliation.”
The nonpartisan Congressional Budget Office estimates that extending the premium tax credit could average $35 billion annually, warning that failure to renew it could leave four million more individuals uninsured than would otherwise be the case.
Tilley fears her family is facing what she calls a “double whammy,” grappling with rising premiums and potential cuts to Medicaid, which is critical for her daughter’s many healthcare needs. “All of her living expenses are covered by Medicaid,” Tilley explained. “Without it, we cannot manage the necessary therapies or medications,” she concluded.
