Significant Premium Increases Cause Decline in Pennsylvania ACA Coverage

Over the past few months, around 145,000 Pennsylvania residents have discontinued their Affordable Care Act coverage following significant premium increases. This trend, anticipated by state officials, is expected to continue until 2026.

Approximately 60,000 individuals departed from Pennie, Pennsylvania's health insurance marketplace, after open enrollment closed on January 31, according to data reported through April. The decline corresponds with predictions made by Pennie officials due to the end of tax credits that previously made premiums more affordable. Without these subsidies, premium costs increased on average by double, with certain regions experiencing even more substantial spikes.

State estimates indicate that up to 150,000 residents could eventually forgo coverage due to these changes. Pennie leaders note that while the initial post-enrollment reduction was less than anticipated, more individuals may discontinue their plans as they grapple with higher costs and the expiration of a three-month grace period for overdue premiums.

Antoinette Kraus, Executive Director of the Pennsylvania Health Access Network, suggested the decline could exceed state expectations. She emphasized the financial pressure on individuals balancing expenses like rent, food, and health insurance. Survey results from her organization revealed that only one-third of participants found their monthly premiums affordable, with one in six planning to cancel coverage.

As some residents transition, they are moving to Medicaid or private insurance. However, Kraus noted that many might choose to remain uninsured. The end of tax subsidies resulted in a 102% average statewide premium increase, with some areas, like Juniata County, seeing hikes as high as 485%, according to Pennie's analysis.

Historically, Pennsylvania saw ACA enrollment growth, with almost 500,000 insured by January 2025. However, the current figure is approximately 452,000, considering 145,000 who left coverage and 80,000 new enrollments during the 2026 open enrollment.

Kraus observed that some remaining Pennie members are switching to lower-tier plans to reduce monthly costs, possibly incurring higher out-of-pocket expenses for unforeseen medical issues. In response, Pennie leaders are advocating for state legislative support to establish a $50 million affordability program aimed at alleviating financial burdens and re-enrolling some individuals who recently canceled coverage. Although authorized in 2024 by the Pennsylvania General Assembly, this initiative has not yet received funding. Governor Josh Shapiro's proposed budget for the upcoming year does not include the requested $50 million, a Pennie spokesperson confirmed.