Following Republicans terminating Affordable Care Act subsidies and President Trump’s One Big Beautiful Bill Act which limits state funding for Medicaid and tightened restrictions to enrollee eligibility, experts say Pennsylvanians are caught up in a national health care crisis – marked by an unsustainable increase in insurance costs, a rising rate of uninsured citizens, and expanding medical debt. And local residents agree.
Isha Weerasinghe, Director of Public Benefits Justice at the Center for Law and Social Policy (CLASP), said while the national crisis impacts every American, states that implemented Medicaid expansion through the Affordable Care Act over the past decade – including Pennsylvania – are feeling the squeeze especially tight.
“Even though it’s not great right now, access will get so much worse,” Weerasinghe said.
She pointed to H.R. 1, more widely known as the Republican-backed “Big Beautiful Bill,” which will soon require expanded Medicaid enrollees to prove they’re meeting work and/or community engagement requirements by reporting twice per year.
Weerasinghe said this bill will also re-define Medicaid’s disability designation, requiring patients to prove a disability will impact their ability to work for a year or more.
“This really limits people who will be defined as disability,” she said. “It’s scary to think about what we’re going to see in terms of eligibility.”
Devon Trolley, director of the Pennsylvania health care exchange (Pennie), said the state marketplace this year saw an overall decline in enrollment for the first time since it launched in 2021.
“It’s unprecedented,” Trolley told the Bucks County Beacon in early January. At the time she said Pennie was losing about 1,000 enrollees per day.
In response, Pennie extended its 2026 enrollment deadline from January 15 to January 31. Trolley said she believed many patients had been waiting until the last minute to enroll in health care, hoping that Congress would vote to extend the ACA subsidies. Though backed by a bi-partisan representation which included Republican Rep. Brian Fitzpatrick, the movement failed.
Earlier this month, Pennie announced the lapse in subsidies resulted in one in five enrollees (about 85,000 patients) dropping coverage. Additionally, those that stayed with Pennie shifted to lower coverage levels, with about 30% more Pennsylvanians enrolling in Bronze plans, compared to last year.
About 79,500 new enrollees signed on to Pennie; however, Trolley said those new enrollees came from other places (employer coverage that dropped off, COBRA, etc.) and did not represent uninsured Pennsylvanians entering into coverage.
Pennsylvania patients, families in crisis
Lynn Weidner of Allentown is a full-time homecare worker who spends 80 hours per week caring for her husband who has cerebral palsy. Her gold plan through the Affordable Care Act is her only form of insurance. She re-enrolled this year with a premium increase of $300 per month (from $400 to $700) due to the drop in subsidies.
“I was paycheck to paycheck last year,” Weidner said. “This year, without cutting anything out, I will be in the negative.”
Weidner said that obtaining health care outside of the ACA is cost prohibitive for her, because of pre-existing medical conditions.
“As soon as the marketplace opened, I was on.”
Shortly after enrolling in a plan through Pennie, Weidner said she obtained bloodwork and learned she is anemic. She now manages the condition with frequent testing and iron infusions, which she said keeps her in medical debt. On top of her monthly premium, she pays a monthly sum directly to the hospital for her debt.
“It just keeps turning over, year over year,” Weidner said. “It never gets to zero.”
Additionally, Weidner had to have dental surgery last year, which she charged to a medical credit card. “So the interest will be going up on that soon.”
Weidner said that over the years she has learned to cut costs wherever she can. Recently she contacted her cable company and downgraded her Internet service. In addition, she said she has had to save pills at the end of her prescriptions to prepare for the next emergency, and make sacrifices at the grocery store to make ends meet.
“For a household that has somebody who’s iron deficient and anemic … we don’t buy any beef,” she said. “Even ground beef is still too expensive.”
She said that she’s considered seeking another job to bring in more money, but with 80 hours spent administering care, there is little time left in the day.
Another former caregiver, Sharon Moon of Yardley, said that she is concerned about the impact of H.R. 1 and the cuts to Medicaid – specifically how she believes they will impact the elderly.
Moon left the workforce several years ago to care for her two elderly parents, who have since passed away. She said that during the five years she cared for them she and her husband moved into her former childhood home and built an addition for her parents to live with them full-time. Her father had Parkinson’s disease. After several years of her parents’ health declining, she said she realized she could no longer care for them on her own.
“I’m not designed to be a 24/7 caregiver,” Moon said. “I don’t think anyone is.”
When she realized that Medicare could not be used to pay for long-term care such as a nursing home, Moon said she turned to Medicaid.
“The only help I could find was through Medicaid,” she said. “It was the only thing that allowed me to keep from losing sleep at night. I had taken such good care of them, and I just couldn’t anymore.”
Moon said she is disheartened by the impact of H.R. 1 she’s already noticing – and she fears nursing homes and long term care for the elderly will be among the first programs cut by states who are facing budget constraints.
“I know that if I went door to door right now, I’d run into at least one elderly couple that needs help that nobody knows about,” Moon said.
Andrea Deutsch of Narberth said she has been speaking out about the country’s “broken” health care system since 2010. She credits the Affordable Care Act with saving her ability to run her small business – a local pet store.
At the beginning of this year, Deutsch said she was loud in public and on social media about her fears regarding her rate, but the increase turned out to be smaller than she expected. Her single rate increased by about $250 (from $600 to the mid-$800’s).
“My fears did not bear out,” she said, noting that while it could have been much worse, the increase was still significant.
“You’re expecting a punch in the gut. Instead, you get a light tap across the face.”
Deutsch, a type 1 diabetic, said that when the ACA first became available, she recognized it as her only option to continue operating as a small business owner. Her previous plan was continuing to increase and becoming cost prohibitive, due to her condition. Deutsch said that if an affordable plan had not become available through the ACA, her only other option would have been to work for a corporation to obtain affordable health insurance.
“The failure of our government to recognize that our system is broken is very problematic. We’re putting profits over people.” – Andrea Deutsch of Narberth
“I was understanding the reality of our broken system back then, and what it’s doing for small business owners,” Deutsch said. “People with chronic conditions … we shouldn’t be cut off at the knees when it comes to working for ourselves.”
Now, with new stipulations through H.R. 1 set to be enacted, access to affordable health care through both the ACA and Medicaid will be further restricted.
“The failure of our government to recognize that our system is broken is very problematic,” Deutsch said. “We’re putting profits over people.”
During a press conference in late January, Trolley said that Pennie officials expect to see more enrollees drop out of the exchange through the end of April and beyond, “as people really grapple with whether they can pay that monthly premium or not.” She said she expects the rate of uninsured and under-insured to continue to escalate in Pennsylvania and across the country.
While she may face a challenging year ahead, Deutsch said she will continue to advocate for small business owners. Weidner said she plans to continue to speak out as a member of her union, Service Employees International Union (SEIU) Healthcare Pennsylvania, and will continue to pressure her local and state representatives to pay attention to the crisis unfolding in health care.
“I would say that it is slow, but speaking up does make a difference,” Weidner said.
Moon said that she also remains hopeful that many of the impacts of H.R. 1 which are future projected can be reversed, either through a change in course of the current Congress or by a new legislation.
She said she believes as time passes, more and more people will wake up to the ripples of impact brought by these legislation changes.
“The complexity is intentional,” Moon said. “It’s designed to hide the bottom line … that [the bill] is designed to cut tons of people off of Medicaid.”
Through her involvement in the local advocacy group Yardley Indivisible, Moon said she is working to spread awareness of these issues to the Bucks County community.
