With no deal in sight, health care costs will rise in 2026. Here’s how that will affect one Lehigh Valley family

For nearly 20 years, Jennifer Doyle has kept her business, Bethlehem Pediatric Therapy Services, running.

Through pregnancy, and a 2023 breast cancer diagnosis and the subsequent treatment, Doyle, an occupational therapist, has powered through, growing her business to 11 employees who offer personalized, affordable care to children with special needs.

But come next month, Doyle, 52, expects her family’s monthly health insurance premiums to rise from $1,900 to $2,400. She said her family already pays $30,000 to $40,000 each year for health care costs, and she doesn’t know how much more she can take.

“At what point does it become too much? At what point do we keep running the business? Should I go work for St. Luke’s or Lehigh Valley [Health Network]?” Doyle said. “ … We do a great service. We really have a tremendous group of therapists. My goal is, of course, to keep things going. It just makes it so it’s really challenging.”

Doyle is one of more than 20 million Americans who purchase their health plans through the health insurance marketplace established by the Affordable Care Act and who can expect to see a significant increase in their premiums starting in January.

A significant factor behind premiums skyrocketing is the sunsetting of the enhanced premium tax credits at the end of this year. These tax credits, temporarily established as part of the 2021 American Rescue Plan Act under President Joe Biden’s administration, help cover the cost of a plan on the marketplace for those who qualify, making some more expensive and comprehensive plans more attainable for some.

Republicans in the House and Senate did not seek to extend these credits in the budget bill that passed in November after a 43-day government shutdown. Despite efforts on both sides of the aisle, an extension seems out of reach.

The latest effort, backed by a handful of Republicans including Lehigh Valley Rep. Ryan Mackenzie, failed to come to a vote this month.

Mackenzie has said publicly he supports extending the credits in some form, and called on the parties to come together in a compromise. He said in a statement that there are two bipartisan options that he has cosponsored that would extend the tax credits and deliver immediate relief on health insurance expenses for families.

“These plans have been available for weeks, and they could be brought to the floor if Democratic leadership would come to the table,” Mackenzie said in a statement. “Unfortunately, [House Minority Leader] Hakeem Jeffries has rejected these bipartisan compromises out of hand and discouraged members of his conference from signing onto a discharge petition.

“There are more than enough Republican signatures on these petitions for them to succeed if Democratic leadership joins the effort and ends the political games,” he said. “Had this occurred earlier this month, the issue of the expiring credits could very well be solved by now. I continue to believe that the fastest, most serious solution to this problem is a bipartisan compromise that pairs an extension in the short term with commonsense reform in the long term.”

According to Pennsylvania Gov. Josh Shapiro’s administration, the nearly 500,000 Pennsylvanians who buy their plans through Pennie’s individual marketplace will see an average 102% increase in the cost of their premiums next year.

Republicans are seeking to address health insurance costs through the Lower Health Care Costs Act, which recently passed in the House. The bill seeks to alter reporting requirements for pharmacy benefit managers, create a cost-sharing program for insurance premiums for low-income Americans and support an existing program where small businesses and buyers are allowed to negotiate lower group rates. However, critics have called this act potentially counterproductive toward its stated aim.

Regardless, it’s too late to extend the tax credits or pass the Lower Health Care Costs Act before 2026 — Congress closed business for the year and most left Washington last week.

Doyle has received surgery, chemotherapy and radiation treatment for her cancer, but she has to take a medication that prevents cancer from growing in her body for two years and a hormone blocker for the next 10 years. On top of that, every year she will need to go through various tests, scans and screens. So despite surviving what she hopes was the worst of her cancer, her individual health care costs aren’t going to go down much anytime soon.

At the same time, her choices for more affordable health insurance options are limited. Because her cancer is a preexisting condition, she can’t get a private health insurance plan.

To reduce the cost of running her business, she’s started taking on more patients personally, which she said has the double edge of leaving her less time to actually run and grow her practice. She added that medical insurance reimbursement rates have remained largely stagnant and she’s making less than she was when she started the business.

“I’m paying a lot more for insurance, but I’m certainly not seeing those as a provider,” Doyle said.

She said if it comes down to it, she isn’t facing total financial ruin — she would be able to work for someone else and get an employee health insurance plan. But that would mean she wouldn’t be able to continue operating her business; her 11 employees would have to go elsewhere, and so would her patients.

“I would be devastated, honestly,” Doyle said. “Running this business is my passion. We don’t make a ton of money from it. But we make enough. We have this amazing group of therapists and I love what I do.”

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