October 20, 2025
by Marc Stier
Originally published on October 15, 2025, at PennLive – Patriot News
The dispute about health care is the central reason the federal government is shut down now. Democrats are telling Republicans in Congress that they will not vote for a continuing resolution to fund the government unless Republicans agree to:
(1) extend the expanded tax credit subsidies that keep marketplace coverage affordable for most people.
(2) reverse the deep cuts to Medicaid that the reconciliation bill, also known as the One Big Beautiful Bill Act, imposed.
Reversing those cuts is critical to hundreds of thousands of Pennsylvanians. Our state cut the uninsured rate nearly in half over the last decade, falling from 13.6% in 2013 to 7.1% in 2023. The big ugly reconciliation bill and the failure to extend expanded ACA tax credits will reverse that progress.
As our recent report shows, by 2034, between 645,000 and 846,000 Pennsylvanians are projected to lose coverage, the uninsured rate will double, premiums will rise sharply for nearly everyone in the marketplace, and safety-net providers will be pushed to the brink.
The enhanced premium tax credits were originally created under the Affordable Care Act in 2010, expanded temporarily in 2021 under the American Rescue Plan Act (ARPA), and then extended through 2025 under the Inflation Reduction Act (IRA).
Before ARPA, subsidies were only available to those with income equaling up to 400% of the federal poverty line (about $120,000 for a family of four).
ARPA removed that “subsidy cliff,” making middle-income families eligible, and capped premiums as a share of income: No one had to pay more than 8.5% of household income for a benchmark plan, with much lower caps for low- and moderate-income households. These changes meant millions of people either paid no premiums or paid much less out of pocket for coverage. In Pennsylvania, average marketplace premiums dropped by hundreds of dollars per month.
The expanded tax credits have led to many more people securing health insurance through Pennie. Pennie concluded its 2025 Open Enrollment Period with a record-breaking 496,661 enrollees.
If Congress lets these subsidies and the share-of-income cap expire, premiums will jump immediately for nearly everyone in the marketplace. And as costs go up, the people who get insurance through Pennie will be more likely to be those with severe medical conditions who simply must have insurance.