Insurance costs to soar in Pa. without congressional action: commissioner

HARRISBURG — Pennsylvania set an enrollment record last year when nearly 500,000 people purchased health insurance through the commonwealth's online marketplace, Pennie, but a surge in costs expected in 2026 jeopardizes their coverage, along with those who may seek insurance through the exchange for the first time.

"An estimated 90 percent of Pennie enrollees will likely pay 82 percent more on average for their health insurance with many paying 100 percent more or even higher without EPTCs," Pennsylvania Insurance Commissioner Michael Humphreys said Wednesday about Enhanced Premium Tax Credits set to expire without congressional action.

During a press call hosted by Families USA, a national health care consumer advocacy organization, Humphreys used as an example a 60-year-old married couple from York County with an annual income of $82,000. Their premium cost about $7,000 in 2025, he said. Next year, he said the cost could reach $35,000.

"That's just not affordable," Humphreys said.

Enhanced Premium Tax Credits expanded both savings and eligibility of existing tax credits authorized within the Affordable Care Act. They were introduced under the Biden administration and are credited with doubling ACA Marketplace enrollment from 11.4 million people in 2020 to 24.3 million in 2025, according to the Peterson-KFF Health System Tracker.

The enhanced credits will expire Dec. 31 without an extension authorized by Congress. The issue is a primary point of negotiations for the latest spending bill as yet another threat of a potential shutdown of the federal government looms Oct. 1.

Data on enrollments and costs of the credits by congressional district are available at www.pennie.com/affordability.

"These premium spikes are the first of many consequences of the big budget bill that was passed earlier this year," Anthony Wright, executive director, Families USA, said. "The premiums are rising and the tax credits that would have helped avoid the rise are being reduced or are expiring altogether."

The American Hospital Association wrote to the respective Republican majorities and Democratic minorities in both the House and Senate this week, advocating for an extension. Without the credits, AHA's President and CEO Richard Pollack wrote that not only will millions of Americans risk losing health insurance, but that hospitals and health systems will experience "considerable stress" due to the potential ballooning of uncompensated care and bad debt.

Citing industry data, the Healthcare Financial Management Association estimates uncompensated care and bad debt reached $46 billion in 2024. AHA reported that the costs topped $42 billion in 2020.

According to Humphreys, more than 150,000 Pennsylvanians could "be forced" to drop insurance coverage due to rising costs. The driving factors for rising insurance premiums are higher hospital costs, costlier outpatient procedures and prescription medications and increased use of health care services generally, he said.

Another 120,000 are expected to lose coverage, he said, because of "restrictive and burdensome policies" included in this year's One Big Beautiful Bill, a continuing resolution that funds government operations through Sept. 30.

"Approximately 270,000 Pennsylvanians out of that 500,000 may be left without health insurance without congressional action simply because they can't afford it," Humphreys said, adding that the commonwealth can't afford to backstop the increases.

The insurance commissioner encouraged all insured through Pennie to check their plan details immediately ahead of open enrollment on Nov. 1. Open enrollment ends Jan. 15, 2026. He said enrollees should check the potential impact on premium costs and compare available plans and ensure their doctors, hospitals and prescriptions are covered. He noted that some plans offering lower premiums bring higher costs out of pocket.

"These increases are not inevitable," Wright said, with Humphreys adding that Congress has until about the end of September to secure an extension of the tax credits.

"They are a policy choice by this Congress and this administration," Wright said.