Pa. residents getting health insurance through the marketplace, brace for huge premium increases

Last year, Julia Tilley and her husband were finally able to purchase their health insurance on the marketplace.

Tilley, a home healthcare worker, takes care of her adult daughter with autism and a physical disability. Her husband has a traumatic brain injury and can only work part-time.

The Harrisburg family is among the more than 20 million Americans for whom pandemic-era tax credit subsidies made healthcare even more affordable.

Now the Tilleys, like the nearly 500,000 people across Pennsylvania enrolled in Pennie, the state’s Affordable Care Act insurance marketplace, are about to see healthcare premiums soar by an average of 102%.

In one scenario laid out by the state Insurance Department, a 60-year-old couple in York County now paying $7,032 will see their annual cost spike to $35,712.

Some say the reason is the rising cost of healthcare and prescription drugs, but Tilley puts the blame mostly on Congress and its inability to reauthorize the Enhanced Premium Tax Credits, which lowered the cost of comprehensive insurance coverage for millions.

Republicans call the tax credit a pandemic-era albatross and want to slash it from the federal budget. Democrats want to extend the credits to protect vulnerable Americans amid the rising cost of living and shrinking safety net programs.

The impasse has led to the federal government shutdown.

Now, with open enrollment underway, Tilley is among the legions for whom affordable health care is about to become a thing of the past.

“I have not gotten my letter yet, so I don’t know exactly what mine’s going to be. It could be $1,200 a month,” Tilley said.

Many insurance providers have begun open enrollment and almost all will by Nov. 1, giving customers a few weeks to decide on their plan for next year.

Tilley said friends of hers have already received their notice and reached out to her in panic. One couple told her their payments would balloon from $100 to $1,800 a month, far beyond their ability to pay.

“There’s really no way to prepare for it,” Tilley said. “I mean, how do you suddenly come up with $15,000 more a year? My husband can’t work more because he has a head injury. I work full-time time taking care of my daughter. It’s not like I can go get another job. So we’re stuck.”

This week, the Pennsylvania Insurance Department released its final health insurance rates for 2026.

“Soon, Pennsylvanians who purchase their own coverage will be receiving renewal letters from their insurers and from Pennie that will contain prices that will be shocking,” said Insurance Commissioner Michael Humphreys in a statement. “Congress still has the ability to act to protect Pennsylvania families, as well families across the country.”

Overall premiums will rise in both the individual market (for people who purchase coverage on their own) and the small group market (for small businesses), state officials said. The rate adjustments reflect ongoing uncertainty at the federal level, along with an increase in medical and drug costs.

In an email to PennLive, Capital Blue Cross it has been advocating for changes to make healthcare more affordable for everyone, including pushing for better payment models.

“Policymakers can play a big role too,” the health insurance provider said. “While rising costs affect everyone, it’s especially true for people who buy their insurance on the individual market who may face an added challenge this year. If federal tax credits go away, a lot of consumers could see their premiums go up significantly.”

Capital Blue Cross covers about 50,000 Pennsylvanians through Pennie, and nearly 80% of them rely on those subsidies to afford their coverage.

“We’re doing everything we can to keep coverage accessible and affordable for all, including for people with employer-sponsored insurance and Medicare members,” the company said. “But it will take continued collaboration across the health care system, including providers, pharmaceutical companies, and policymakers. Healthcare affordability has to be a shared responsibility.”

Antoinette Kraus, executive director of the Pennsylvania Health Access Network, called the projection a “staggering increase” that “puts an unacceptable burden” on those who purchase insurance through Pennie.

“Pennie enrollees, many of whom are small business owners, gig workers, servers at restaurants, substitute teachers, homecare workers, retail workers, and others who are not offered employer-based insurance, will face this increase while their budgets are already strained by rising costs in other areas,” Kraus said.

Advocates like Kraus estimate that half of current Pennie enrollees are likely to drop coverage altogether, and hundreds of thousands more will have to make difficult choices like getting a plan with far less coverage, avoiding seeing the doctor, rationing necessary medications, or going without other necessities.

“For people living with diseases like cancer or diabetes, this could be the difference between getting lifesaving treatment or going without it,” Kraus said.

Tilley said the dramatic increases will impact everyone.

“It’s not just going to affect the people that have insurance,” she said. “I mean, we’re not going to have insurance, which is going to be catastrophic. People are going to lose their homes. They’re not going to be able to afford their car payments. Already food prices are rising. So something has to give, and it’s going to be health care. People aren’t going to be able to afford it and we’re going to end up with people being sicker.”

Tilley said she has tried multiple times to deliver her message by phone email and in person, to her congressman, Rep. Scott Perry, a York County Republican, but said she has yet to hear back from his office.

This fall, she traveled to Washington, D.C. and met with several lawmakers, albeit all were Democrats who support extending the tax credits.

PennLive reached out to Perry’s office for comment but did not hear back. Calls to other members of Congress in the region, Rep. Dan Meuser and Rep. Lloyd Smucker, also were not returned.

Perry’s 10th congressional district has about 32,000 residents enrolled in the ACA marketplace — roughly 4% of the population, according to a report by the Kaiser Family Foundation, a healthcare advocacy group.

Nearly six in 10 marketplace enrollees (57%) live in congressional districts represented by a Republican, Kaiser found.

“This is a bipartisan issue,” Tilley said. “It isn’t just Democrats that are going to lose their insurance. It’s everybody. It’s Republicans, it’s Democrats, it’s independents, it’s people who aren’t registered to vote.”

The non-partisan Congressional Budget Office estimates that extending the premium tax credits would cost $35 billion per year, on average. If the enhanced tax credits are not renewed, the CBO also estimates that about 4 million more people would become uninsured than otherwise would have been the case.

Tilley worries that her family is facing a “double whammy,” on top of the premium hikes they are looking at potential Medicaid cuts mandated under the budget bill signed into law by President Donald Trump in July. Republicans say it reduces government spending and adds protections to programs.

“My daughter’s everything is funded through Medicaid,” Tilley said. “Her medical insurance, her speech therapy, the physical therapy, her counseling, her medications. She’s on seven different medications a day. And my pay is funded through Medicaid. So that in and of itself is very precarious. There’s just no way that we could ever afford all of the services that she requires.”