Pa. insurance chief fires back at ACA ‘fearmongering’ claim, warns of hikes

Pennsylvania Insurance Commissioner Michael Humphreys clapped back on criticism of his department’s characterization of the loss of Obamacare subsidies, noting that the resulting potential healthcare cost increases are “even worse” than first thought.

Humphreys fired back at U.S. Rep. Lloyd Smucker, R-Pa., over a Nov. 4 letter in which Smucker accused the department of “fearmongering” over the potential loss of the subsidies.

“The Department’s claims about ‘skyrocketing’ premiums are misleading and paint a false picture for consumers,” Smucker wrote. “The reality is, most Pennsylvanians will continue to qualify for affordable coverage and the average after-tax premium on HealthCare.gov for 2026 will be just $50 per month.”

In a letter of his own released Thursday, Humphreys said the congressman is mistaken and presenting an incomplete picture. Most subscribers are likely to see their monthly premium double. In the worst case, some subscribers, he said, could end up paying more than 6 times what they are paying now monthly – an increase of over 500%.

Pennsylvanians are served by Pennie, a state-run health insurance marketplace that helps residents find and enroll in affordable health coverage. It is a collaboration between the state and private insurance companies that offers a platform to compare plans and get financial assistance, and it provides information on programs like Medicaid.

Humphreys is an appointee of Gov. Josh Shapiro, viewed as a potential Democratic presidential nominee in 2028. His letter was co-signed by Devon Trolley, executive director of Pennie.

“Based on actual data for 2026, Pennie enrollees in your district will pay 93% more to keep their 2026 coverage, compared to what they pay today, reflecting an average per person monthly increase of $199,” Humphreys wrote. “For couples, this is a nearly $400 increase, and for a family of four, nearly $800 more each month.”

Some national estimates look at cost increases for the lowest-cost plans, Humphreys noted, but the majority of those plans have the most limited networks and very high deductibles.

“Pennie’s numbers look at the change in cost of the actual plans that individuals have carefully chosen for their families,” Humphreys explained. “This approach is more representative of the cost increases Pennie enrollees are experiencing for 2026 coverage without the enhanced premium tax credits.”

A phone call and emails to Smucker’s office were not returned. Congress reached an agreement last week to end the government shutdown, but it merely gives lawmakers two months to find a solution to offset the loss of ACA subsidies.

'Full transparency'

In his letter, Smucker requested “full transparency on the assumptions underlying” the insurance department’s example of a married couple in his district and the cost impact on their health insurance. Smucker asked for the couple’s age, income, and rating area factors.

The department’s scenario is based on a married couple, both 60 years old, living in York County, Pennsylvania, and making just over 400% of the federal poverty level, or $84,601, based on the benchmark silver plan premium, Humphreys said.

This couple will go from paying $581 per month in 2025 to paying $3,703 per month for the same coverage in 2026, due to losing premium tax credits.

“When re-looking at this scenario after receiving your letter, we found that the increase is even worse with actual 2026 plan costs than originally estimated using 2025 plan data,” Humphreys wrote.

The updated increase for the hypothetical couple will actually be 532% and their cost for their monthly premium will consume 53% of their income (instead of 44%).

“We appreciate you bringing our attention to this scenario so we could update it to reflect the updated and worsened scenario,” Humphreys wrote.

Older enrollees especially vulnerable

Humphreys noted that older enrollees above the 400% of the federal poverty level represent “the worst-case scenarios” in Pennsylvania, but do not represent the “outlier” scenario that Smucker had claimed.

The department estimates that about two-thirds of the “tens of thousands” of enrollees above the income cliff that will lose all ACA tax credits are between 55-64. Smucker claimed that “only 0.28% of the enrollees” in his district are above this income cliff.

That figure is more like 13%, Humphreys said, which exceeds the Pennsylvania statewide average of 9.2% of Pennie enrollees being above the 400% poverty line.

“Your letter mentioned this population could receive coverage through their employer, yet as I’m sure you’re aware, a long-standing condition of enrolling in Pennie is that employer coverage is not an option,” Humphreys wrote.

Smucker claimed that the Pennsylvania Insurance Department "holds substantial authority to lower costs but has declined to exercise it." He cited several options:

• Expand short-term limited duration insurance (STLDI) beyond minimum federal limits to provide working families more affordable bridge coverage.
• Encourage Association Health Plans and level-funded arrangements to help small businesses and self-employed workers pool risk and reduce costs.
• Approve Health Savings Account-eligible catastrophic plan designs, now made possible under federal law, which the Working Families Tax Cuts legislation expanded to every county and every consumer on HealthCare.gov.
• Use reinsurance waivers or rate review flexibility to reward innovation.

These are options with “significant drawbacks,” Humphreys said. STLDI policies are medically underwritten, with premiums to match, and will likely not offer mental health benefits and will likely exclude coverage of any pre-existing conditions, among many other exclusions.

AHPs may be an option for small businesses and self-employed workers, the commissioner said. However, there are complex state and federal laws and regulations, he added.

“Finally, catastrophic plan options are available through Pennie in every county,” Humphreys said. “While these plans do not have the same potential enrollment barriers as those in STLDI mentioned above and similarly offer relatively low up-front costs, their coverage limitations and consumer cost-sharing responsibilities often impose significant out-of-pocket costs on consumers when they receive healthcare services.”

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InsuranceNewsNet Senior Editor John Hilton has covered business and other beats in more than 20 years of daily journalism. John may be reached at [email protected]. Follow him on Twitter @INNJohnH.