Since the Big Beautiful Bill (BBB) went into effect at the beginning of this year, we are subject to a huge drop in Federal aid to Pennsylvania for Medicaid and the Affordable Care Act (ACA) subsidies.
A KFF (formerly Kaiser Family Foundation) survey found that 44% of ACA recipients stated that the doubling of their insurance premiums and the reduction in tax credits made it very difficult to afford necessities. In 2026 if you were a single person you had to earn less than $62,600/year and a couple less than $84,600 to be eligible for any tax credit assistance. Consequently, there has been a decline in ACA enrollment, increasing the number of uninsured people in our communities. In 2026, according to PHAN (Pennsylvania Health Access Network) 177,000 Pennie enrollees have dropped their coverage. Pennie is the Marketplace access for PA citizens to obtain ACA health plans. The self-employed or those who do not work for a business that provides some health coverage are most likely to need insurance through Pennie. They can include business owners, wait staff, hair stylists, barbers, lawyers, farm workers, horse trainers, and a host of other gig workers.
Many families are in a bind. They make too much money for Medicaid benefits and too little to be able to afford ACA health insurance, thus falling into the growing pool of uninsured.
The BBB also increased the restrictions and eligibility requirements for Medicaid, making it more difficult for recipients to stay on the program. It should be noted that 85% of families receiving Medicaid had a family member working full- or part-time. A family of four could only earn up to $33,000/year. This translates to 378,000 Pennsylvanians losing Medicaid and 270,000 who will lose Pennie by 2028.
The funding cutbacks resulting from the BBB are one driver of the health care affordability crisis. There are many other drivers. One such driver of today’s health care affordability crisis — and one that has received very little coverage in the press or attention from Congress — is the growing practice of private equity buying out physician practices and adding another layer of costs for their management services.
Today, we see big business investing in all aspects of health care with the sole motivation to bring big profits to shareholders. Private equity companies are now inserting themselves into buying specialty physician practices because they know there is money to be had.
According to a 2024 article in Missouri Medicine by Andrew Schlafly, private equity companies by 2024 owned 30% of all for-profit hospitals and thousands of medical practices, involving “many tens of thousands of physicians.” The result is that in 2023, 20% of healthcare companies filed for bankruptcy because of the aggressive debt-funded strategies of their private equity owners. It is not that the owners ran out of money. It is that, because of tax loopholes, it is profitable for them to load the healthcare companies they purchase with debt while obtaining loans that they then distribute to their investors. This results in poor quality of care; loss of staff or providing care with a lower level of qualified staff; firing of employees; equipment shortages; and increasing prices. One study showed that private equity-owned providers increased insurances prices by 20% as opposed to practices owned by private physicians. These numbers are surely even larger today.
There is a theory that the profit motive will produce excellent products. When I was a nurse consultant for the U.S. Centers for Medicare and Medicaid, I did not find this to be the case. The best nursing homes I surveyed were most often ones that had a different mission other than profits for shareholders. They were usually religiously affiliated organizations whose mission was to care for vulnerable patients, and they also placed high value on their staff. Profit was not their driving force.
How can we find a system that will provide quality health care for all citizens and reimburse providers of health care services in an equitable way while not enriching corporations and shareholders?
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Mary Frances Colvin, a retired nurse, lives in Gettysburg. She is a member of the Democracy for America (DFA) Health Care Task Force (gettysburgdfa.org).