ACA subsidy expiration slams Central Pa. with more than 240% premium increases

LEWISBURG — The expiration of enhanced federal subsidies under the Affordable Care Act (ACA) is expected to sharply raise health insurance costs across Pennsylvania, with hospital leaders warning the fallout could leave patients sicker, strain rural hospitals and ripple into Medicare as insurers scale back benefits. Central Pennsylvania is projected to experience the steepest increases in the state.

Allen Fasnacht, president of WellSpan Evangelical Community Hospital, said the loss of Affordable Care Act protections threatens to erode coverage and undermine access to preventive care, particularly in rural communities already operating on thin margins.

"I do have concerns," he said. "I think our patients will come in sicker due to the erosion of that coverage."

Congress has not extended the Enhanced Premium Tax Credits, which expired Dec. 31. The credits had provided about $600 million annually to make coverage more affordable through Pennie, Pennsylvania's official health insurance marketplace. Pennie enrollment reached a record high of more than 500,000 enrollees in 2025, according to marketplace data.

With the credits no longer available, Pennie enrollees are expected to see average premium increases of 102%. The impact is expected to fall heaviest on rural counties, where residents historically received more premium tax credit support than those in urban areas.

According to the Pennie website, Union County enrollees face an average premium increase of 246%, or about $316 more per member per month. Snyder County premiums are projected to rise 258%, or $275 monthly, while Northumberland County enrollees could see a 280% increase, or about $265 more per month.

Fasnacht said early conversations with community members suggest some residents are already dropping coverage because they can no longer afford it.

"With the expiration of the ACA, those individuals are really excluded from that availability of that coverage," he said. "They've dropped coverage. … And they said, 'If I have to go to the hospital... I will have no insurance coverage at this point due to the expenses.'"

While WellSpan Evangelical has not yet seen a significant rise in charity care or financial assistance requests, Fasnacht said it is still early and the effects are likely to build over the coming months. He said uninsured patients are less likely to seek preventive care, increasing the likelihood of more advanced illness and higher costs later.

"There's strong evidence that shows the uninsured will seek less preventative care, resulting in reducing the ability for early detection and better management," he said.

Hospitals are legally required to provide emergency care regardless of insurance status, and Fasnacht said urgent care centers and emergency departments remain available for patients who need treatment. Still, he said the loss of coverage limits options for routine and primary care, depending on where patients typically receive services.

Financial pressures tied to coverage losses could also limit hospitals' ability to reinvest in staff, services and infrastructure, Fasnacht said, particularly in rural areas.

"As a rural hospital or the rural community, we're particularly vulnerable, where obviously our margins are a little bit thinner and our payer mix is heavily towards government-funded programs," he said.

Fasnacht said Medicaid reimburses hospitals about 71 cents for every dollar of care provided, while Medicare reimburses about 83 cents per dollar. Combined with rising costs and an aging population with more complex health needs, he said hospitals are facing "the perfect storm."

WellSpan Evangelical and its parent system have historically provided significant community benefits, including charity care and unreimbursed services. Before joining WellSpan, Evangelical reported between $50 million and $56 million annually in community benefits. Systemwide, WellSpan reported $364 million in community benefits in its most recent report.

Beyond the ACA marketplace, changes affecting Medicare beneficiaries are also emerging.

Holly Kyle, executive director of the Union-Snyder Agency on Aging, said some Medicare Advantage plans have reduced benefits during the current Medicare Advantage Open Enrollment period, which runs from January through March.

"What we have heard is that some of the Advantage plans have reduced the number of benefits that they are offering," Kyle said. "In some instances, it could be that there were benefits such as a food option that is no longer being offered under the Advantage plan."

Kyle said reductions vary by plan and insurer, noting that decisions about what is covered ultimately affect what services older adults can access when they need care.

"It's up to each plan what they are and are not going to cover, but it's ultimately then going to impact what is available to an older adult when they need to use their particular plan," she said.

Kyle said Medicare Advantage plans often include additional benefits beyond traditional Medicare, but federal-level changes have prompted insurers to reassess what they can afford to offer.

The agency has not seen a surge in calls yet, Kyle said, but beneficiaries enrolled in Medicare Advantage plans can make a one-time change during the open enrollment period. She said residents in Union and Snyder counties can contact the agency to speak with PA MEDI (Medicare Counseling) counselors for help reviewing coverage options.

Fasnacht said stabilizing coverage and affordability will be critical to protecting access to care.

"We obviously need policy innovations to stabilize the coverage under the ACA, preserve affordability through exchanges like Pennie and address chronic under-reimbursement," he said. "Otherwise, hospitals will continue to face difficult trade-offs that could limit access."

He said hospitals and health systems will continue to advocate with state and federal leaders as they navigate ongoing changes, emphasizing that access to care remains the central concern for communities across the region.