Sasha Kinney fears she cannot afford the $750 a month it will cost to keep her Affordable Care Act health plan in 2026. But she will put the insurance bill on a credit card before risking a medical emergency without access to the doctors she sees regularly.
The 42-year-old Drexel Hill resident’s insurance costs soared this year, after Congress did not extend a federal incentive program that ensured that no one paid more than 8.5% of income on health coverage.
She earns enough doing freelance work for nonprofits, while serving as her mother’s primary caregiver, that she is not eligible for Medicaid, the publicly funded health program for low-income people.
A private health plan through Pennsylvania’s Obamacare marketplace, Pennie, was a major expense, but one she prioritized to help manage her chronic headaches and stress-related pain. But the incentive program expired at the end of last year, leading to skyrocketing ACA insurance costs in Pennsylvania and across the country. Kinney will now pay an extra $250 without the added tax credit.
“I will go into debt because of these increasing costs,” she said. “But it still seems better than not having coverage.”
Congress has failed so far to strike a deal to bring back tax credits that have helped record numbers of Americans get health insurance. The U.S. House of Representatives approved legislation last week that would renew the program for three years, but it is unclear if the Senate will act.
President Donald Trump on Thursday announced a healthcare plan that White House officials said would help address rising healthcare costs by creating new drug price controls and sending health subsidies directly to consumers. The sparsely detailed plan is intended to serve as a framework for Congress, though officials did not say which lawmakers are actively working on new healthcare legislation, the Associated Press reported.
Meanwhile, people who are covered by Obamacare plans are running out of time to decide how to handle massive price hikes that doubled the average cost of the health plans in Pennsylvania.
The deadline to enroll in a plan for 2026 in Pennsylvania and other states is Jan. 31. After that date, people can drop their coverage if they find it is too expensive, but they will not be able to select a new plan until the fall enrollment period.
In Pennsylvania, about 70,000 people who bought Pennie plans in 2025 have decided they cannot afford the price increase and dropped their coverage. The dropout rate is unprecedented — about 1,000 people a day, said Devon Trolley, Pennie’s executive director.
Nationally, about 800,000 fewer people have selected Obamacare plans compared with this time last year, a 3.5% drop in total enrollment so far, according to the AP.
With just weeks to go in the enrollment period, marketplace leaders are urging people to think carefully about whether they can afford their plan for the full year and to look at other Pennie plan options. If Congress ultimately renews the enhanced tax credits, they have said, they would work quickly to adjust prices.
“At this point, we are telling people they should make the best decision for their family based on the current cost,” Trolley said. “We want to make sure people who currently have coverage aren’t staying with a plan they can’t afford.”
Trolley worries that people will stick with a plan they like, not realizing they can no longer afford it, only to be forced to drop the coverage and become uninsured partway through the year.
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Congress considering tax credit extension
The add-on tax credits that expired at the end of 2025 were introduced in 2021 and have been renewed by Congress annually since then.
In Pennsylvania, the federal incentive program ensured the vast majority of enrollees qualified for at least some amount of financial help, driving peak marketplace enrollment of 497,000 in 2025.
The program became a major sticking point in federal budget discussions last fall, with Democrats forcing a government shutdown after Republicans refused to include the tax credits without significant restrictions.
The budget ultimately passed without the tax credits after key Senate Democrats, including Pennsylvania’s John Fetterman, voted with Republicans to end the shutdown.
Last week, 17 House Republicans — including Pennsylvania Reps. Brian Fitzpatrick, Robert Bresnahan, and Ryan MacKenzie — sided with Democrats to approve legislation that would reinstate the tax credits for three years. The measure must be approved by the Senate, and would need to return to the House to consider any changes.
While the incentive program’s expiration is a major blow to the Obamacare marketplaces, Trolley, Pennie’s executive director, urged people not to rule out finding affordable coverage.
President Barack Obama’s landmark health law also included income-based tax credits for people who earn less than 400% of the federal poverty level — about $60,000. These tax credits cannot expire because they are part of the law.
“We have been encouraging people to not assume it’s too expensive,” Trolley said.
Health insurance decisions
While some parts of Pennsylvania are seeing prices three to four times higher than in 2025, Philadelphia’s collar counties are seeing more moderate cost increases, ranging from an average 46% price hike in Chester County to a 70% average increase in Delaware County.
Other factors that affect cost include household size, age, and income. People who are generally healthy and use insurance sparingly may be able to save money by opting for a plan that has a low monthly cost and a higher deductible (the amount of money spent out-of-pocket before the plan begins covering a greater share of costs).
In Drexel Hill, Kinney considered switching to a cheaper plan when she saw how much it would cost to keep her current coverage.
Her current plan has a low deductible, and even so, Kinney said, she still spends hundreds on co-pays and other costs not covered.
She worried that if she switched to a plan with even higher out-of-pocket costs, she would end up skipping appointments and avoiding needed care.
She routinely sees doctors and physical therapists, and didn’t want to risk having to find new providers.
“In the end I think it washes out — you can lower your monthly cost, but if the deductible and co-pays are higher, you’re paying the same,” she said. “There’s basically no way to save money.”
