Congressional health insurance tug-o-war puts Pennsylvanians in a lurch

by Whitney Downard, Pennsylvania Capital-Star

Jamie and Carrie Wright rattle off the numbers with ease.

wrights

Jamie, left, and Carrie Wright live in McKeesport, Pennsylvania, and rely on federal premium tax credits to pay for Jamie's cancer treatment. Those subsidies are set to expire at the end of the year. (Photo courtesy of Carrie Wright)

It's $36,000 for a single dose of Jamie's cancer-suppressing shot, which he needs every 28 days. A patient support program will cover the $1,400 copay, but that means it doesn't count toward their $15,000 in out-of-pocket costs. Neither did the $1,167 Carrie needed for a copay before her nerve ablation last month.

Then, there's Jamie's scans every six months and her thyroid medication…

The Wrights juggle the above costs with the assistance of Ipsencares (which pays for the shot's copay) and credit cards. But there's one number that they haven't squared away: $1,792. That's their projected monthly insurance premium in 2026 if Congress doesn't extend enhanced marketplace tax credits. Jamie Wright, left, doesn't look sick most days, says his wife Carrie. But his cancer treatments do take a toll a few days a month. (Photo courtesy of Carrie Wright)

That's 265% more than their current $490 monthly premium, which is significantly reduced by federal tax credits.

"We're fortunate," said Carrie, noting they have adult children. "We only have the two of us to support, versus a family. But $1,792 is going to mean some significant changes … not just to our lifestyle, but the necessities."

The Wrights, who live in Allegheny County, are just two of the roughly 500,000 Pennsylvanians who rely on insurance plans sold through Pennie, the state's Affordable Care Act marketplace. The tax credits used to reduce premium costs are due to expire at the end of the year, and costs are expected to more than double statewide on average if Congress can't decide on a path forward.

"We know that these subsidies really make health insurance affordable for cancer patients and their families," said Donna Greco, the government relations director for Pennsylvania's American Cancer Society chapter.

"It really is a matter of life and death knowing how critical having health insurance coverage is in a person's ability to prevent, detect, treat, and survive cancer," she added.

Though several plans have been floated, none are expected to cross the finish line in Congress.

"It ain't about political affiliation, because it doesn't matter. It's hurting people across the board," said Jamie. "It doesn't matter who has the plan, but they need to fix this now … do an extension, do whatever you've got to do. Fix the problem right now and then come up with a plan."

The McKeesport couple made roughly $81,000 last year and don't qualify for coverage through their respective jobs. Carrie, 54, works for a local eye doctor while Jamie, 60, installs trim with a window and door company.

Though he strives to work a full-time schedule, Jamie often can't.

The tumor-suppressing shot every 28 days "takes him out," in the words of Carrie, and requires a few days of recovery time. One of his medications impacts his blood pressure, a danger if he gets light headed while working on scaffolding.

But he maintains that he'll work more hours "or whatever I need to do … to figure this out."

"It's not that his work ethic is bad," said Carrie. "His capability to work is not the same."

"I still get it done," he responded.

"But that's the thing — when he should be staying at home to take care of himself, he can't," said Carrie.

"If I need to pull more hours, or whatever I need to do, I'm going to figure this out … we have to survive."

– Jamie Wright

Doctors diagnosed Jamie with neuroendocrine tumors in 2021, a type of slow-growth cancer that spreads throughout the body. At one point, he had more than 80 tumors, but cut that number by 50 after an individualized treatment through a clinical trial at the National Institutes of Health in 2023.

"One of the things with this particular cancer, even though it's slow-growing, it'll change. It's always in your body and you can't get rid of it," said Jamie. "When you have higher numbers, the chance of metastasizing and jumping to another organ or jumping to the bone or somewhere else increases."

Shortly after the 2023 clinical trial, when Jamie could no longer work full-time, and money got tight, they learned about the tax credits through Pennie.

"That tax credit has helped. Oh my God, has it helped?" said Carrie.

Most ACA marketplace users can't afford potential increases, poll shows

Transitioning to a lower-quality or lower-premium plan wouldn't meet their needs, the Wrights said, and might just come with even higher deductibles or copays.

"We get some pretty good care, right now. Having cancer, and a lot of the things that I have to go through, you have to be conscious about what's important. And that care is important," said Jamie.

Carrie worried about other people opting out of coverage, driving up prices for people like them who can't afford to go without.

"If those people drop their insurance, we can't. Cancer says you have to have insurance. And if all of those hundreds of thousands or millions of other people lose their insurance or drop it — what's that going to do to our premiums?" Carrie asked.

The Philadelphia Inquirer reports that 30,000 residents have dropped their coverage ahead of the end-of-year deadline.

She also wondered if the tumor-suppressing shot, which is made in France, would be subject to future tariffs and potentially double in price.

But the couple is still active at home, when possible. Jamie built a cat shed with heat lamps for the neighborhood's cats — eight of whom now live indoors with the Wrights as it gets colder.

In the warmer months, they distribute popsicles to children in the community. These children brought them Simba, a cat whose "eyes were glued shut" with an infection, as Carrie documents on her Facebook page and TikTok where she fundraises for feline vet care.

"I always joke that we're hashtag cats and kids. Because we have all the neighborhood strays," said Carrie.

But the Wrights acknowledge their life will change if the credits expire.

On The Hill

Two proposals in the U.S. Senate failed to muster enough support Thursday: a Democratic plan to extend tax credits for three years — with an $83 billion deficit increase over the next decade — and a Republican alternative that would provide up to $1,500 annually for certain purchasers and end the subsidies.

A vote is expected in the U.S. House next week, but specifics remain elusive. The narrow 220-213 GOP majority means that every member would have to support the measure, even before moving to the Senate.

The projected premium increase could hurt swing district Republicans, including those in Pennsylvania, as reported by AP.

Both Congressman Ryan Mackenzie in Lehigh Valley's 7th District and Congressman Brian Fitzpatrick in Bucks County's 1st District — who narrowly won their districts in 2024 — have been part of bipartisan coalitions pitching alternatives temporarily extending credits.

The ever-optimistic Wrights use credit cards to pay their medical expenses sparingly for now, but Carrie worried they might be facing a "mountain of debt" in the future. Lawyers told them that disability wouldn't be an option until Jamie had been out of work for at least six months.

"We're going to figure it out," said Jamie. "But there's a lot of people that I've talked to … not only are they getting punched in the face with cancer, then they got to deal with this mess."

"They should be worrying about getting themselves better, not how they're going to pay for it," added Carrie.

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