HARRISBURG — More than 100,000 Pennsylvanians have lost their health insurance through Pennie, the state’s health insurance marketplace, since the expiration of enhanced premium tax credits at the start of 2026. The loss of these subsidies, which significantly lowered monthly premiums for many, is creating a ripple effect of affordability concerns and coverage cancellations across the commonwealth.
Devon Trolley, Pennie’s executive director, estimates that 104,000 former customers have dropped coverage, citing cost as the primary reason. That figure had already reached approximately 85,000 by February 1st, and Trolley told members of the House Appropriations Committee that the number continues to climb daily. The situation highlights the precariousness of health insurance affordability for many Americans and the impact of federal policy decisions on state-level programs.
The enhanced premium tax credits, a key component of the Affordable Care Act, were extended through the Inflation Reduction Act of 2022. However, when Congress allowed those credits to expire, premiums for Pennie enrollees effectively doubled, according to Trolley. This dramatic increase is particularly acute in rural and central Pennsylvania, where some counties saw average cost increases exceeding 400%, as reported in October 2025. The loss of these credits has created a significant barrier to access for many Pennsylvanians.
Enrollment Shifts and Rising Costs
Despite the cancellations, Pennie’s total enrollment currently stands at 471,000, down from 497,000 at the close of open enrollment in 2025. The influx of new enrollees is partially offsetting the loss of existing customers, but Trolley anticipates further cancellations as policyholders receive their first bills reflecting the higher premiums. More than half of those currently enrolled have indicated that even at the new rates, coverage doesn’t fit their budget, signaling continued financial strain.
The average premium cost across Pennsylvania rose by 102%, an additional $157 per month. Fifteen counties experienced increases exceeding $200, and seven counties in central, south-central, and east-central Pennsylvania saw average increases topping $300 per month. These increases are disproportionately impacting older adults ineligible for government-subsidized plans and younger individuals willing to risk going uninsured, Trolley explained.
A National Trend with Local Impact
The situation in Pennsylvania mirrors a national trend. The expiration of the enhanced tax credits was projected to impact millions of Americans, potentially adding 3.8 million people to the ranks of the uninsured. Supporters of extending the credits argued that maintaining affordable coverage would prevent hospitals from accumulating unpaid debt and keep costs down across both the individual and commercial insurance markets by ensuring a healthier risk pool.
The decision to let the credits lapse stemmed from concerns about the federal budget deficit. A proposed extension through 2035 was estimated to add $350 billion to the national debt, according to reports at the time. This fiscal calculation weighed heavily on the Republican-led Congress, ultimately leading to the credits’ expiration.
State-Level Responses and Future Outlook
Pennsylvania Governor Josh Shapiro has stated that the state lacks the financial resources to backfill the lost federal funding. New Mexico, however, has taken a different approach, providing state funding to continue the enhanced credits, resulting in a 14% increase in enrollment, Trolley noted.
Insurance Commissioner Michael Humphreys emphasized that Congress retains the power to reinstate the credits at any time, but acknowledged there is currently no momentum to do so. “People don’t stop getting sick because they don’t have health insurance,” Humphreys said, underscoring the broader consequences of reduced coverage. “The remaining pool is less healthy compared to those who were in the pool prior… It impacts, really, the entirety of the health care ecosystem.”
The ongoing situation raises questions about the long-term sustainability of Pennie and the accessibility of affordable health insurance in Pennsylvania. The state’s budget hearing testimony from Devon Trolley, available on the House Appropriations Committee website, provides further detail on the challenges facing the marketplace.
The next key date to watch is the ongoing legislative session in Congress. While no immediate action is anticipated, any shifts in political priorities or budget negotiations could potentially revive the discussion around extending the enhanced premium tax credits.
What are your thoughts on the rising cost of health insurance? Share your experiences and perspectives in the comments below.
