Enrollment in Pennsylvania’s Affordable Care Act marketplace, Pennie, is declining sharply as higher monthly premiums take effect following the expiration of enhanced federal subsidies, raising concerns about affordability and access to health coverage across the state.
At least 70,000 Pennsylvanians have left Pennie so far this year, according to program officials. Enrollment had reached a record 497,000 people in 2025, but current participation has fallen to between 465,000 and 472,000, with nearly 1,000 people terminating coverage each day. Open enrollment, which was extended this year, runs through Feb. 1.
The drop comes as monthly premiums rise significantly for many enrollees, particularly those whose incomes exceed the cutoff for enhanced subsidies. Pennie Director Devon Trolley said cost has emerged as the dominant reason people are leaving the exchange.
The steepest increases are hitting older adults. For enrollees over age 55 who earn more than roughly $62,600 as individuals or $84,600 as couples, premiums have in some cases tripled or quadrupled. Trolley said a typical 60-year-old couple that paid $500 to $600 per month last year may now face bills of $2,000 to $3,000, consuming as much as half of their income.
That pressure is forcing families and small business owners to make difficult trade-offs. Andrew Gehman, a 40-year-old video production company owner in Franklin County, said his monthly premium jumped from $70 to $240. To offset the increase, he cut a $12,000 business contract. Gehman said health insurance remains essential, but the cost is increasingly hard to manage.
Similar concerns are shared by Scott Cannon, a 61-year-old videographer from Luzerne County. Cannon and his wife saw their premium rise from $83 to $283 per month. With work becoming less consistent, he said he canceled long-standing business expenses to cover the difference and worries about gaps in coverage for his youngest daughter.
Health advocates warn that declining enrollment could have long-term consequences, especially for older adults who rely on preventive care to manage chronic conditions before reaching Medicare eligibility at age 65.
Meanwhile, uncertainty in Washington continues to complicate the outlook. The U.S. House recently voted to extend enhanced subsidies for moderate-income enrollees for three years, a move that would reduce premiums but carries a significant federal cost. The measure now heads to the Senate and would require approval from President Donald Trump.
Several Pennsylvania Republicans — Reps. Brian Fitzpatrick, Ryan Mackenzie and Rob Bresnahan — joined Democrats in supporting the House bill, while other GOP members opposed it. The Senate is pursuing its own health care package, leaving the future of subsidies uncertain.
Trolley said a straightforward extension would be easiest to implement, but any delay or changes could prolong instability. If Congress acts, Pennie plans to provide opportunities for residents to re-enroll or adjust coverage, depending on the timing and scope of any subsidy extension.
Source: PA Capital-Star