Pennsylvania's Health Care Crossroads: What's at Stake in 2026?

2026 could see half a million residents without insurance

Pennsylvania is facing a significant health care crisis. In 2026, a substantial number of residents may lose their health insurance due to the expiration of enhanced tax credits tied to the Affordable Care Act (ACA). These credits have been instrumental in making health insurance affordable for many, but Congress has not extended them, and the potential fallout could be severe.

The Complex Situation

The same legislation that allowed these credits to lapse also cut Medicaid funding by a significant amount. This has sparked a heated debate between political parties, with each side firmly entrenched in their positions. For Pennsylvania, the impact could be profound:

• Premiums for ACA marketplace plans are expected to rise by about 22% in 2026.
• If the credits expire and the Medicaid cuts take effect, nearly half a million residents could lose their health insurance.

Beyond the Numbers

This crisis is not just about statistics; it's about real people and their access to essential health services. Six hospitals and homes could close, affecting the entire community, not just those with insurance. The ACA, enacted in 2010, has been a vital tool in making health insurance accessible. It provides tax credits for those with incomes between 100% and 400% of the federal poverty level. In 2021, these credits were enhanced, extending their reach to more people.

The Stakes Are High

The Congressional Budget Office estimates that about 2.2 million people nationwide could lose insurance if the credits aren't extended. Other projections suggest this number could be even higher. The consequences of losing insurance are serious:

• People without insurance are less likely to receive necessary care.
• They are more likely to be hospitalized for preventable conditions.
• They face a higher risk of premature death.

This is a public health crisis in the making.

Adding to the Uncertainty

The ongoing government shutdown, which began after Congress failed to pass a budget due to disagreements over the ACA tax credits and Medicaid cuts, adds to the uncertainty. Democrats and Republicans are at an impasse, each side insisting on their conditions for reopening the government. With open enrollment for ACA plans beginning on November 1, 2025, the need for clarity is urgent. People need to know what kind of support they can expect when choosing their health plans.

The Political Fight

The political battle is intense. Democrats are hoping that the popularity of these tax credits will rally public support for their extension. They are using the shutdown as leverage to reverse the Medicaid cuts. Republicans, however, want these issues debated separately. The outcome of this standoff will have significant implications for Pennsylvanians and millions of middle-class Americans. If the enhanced credits end, the consequences could be devastating.