Pennsylvania families with disabilities face health care cliff, Senate must act now

1-28-26

By Amy Cline
As health insurance notices arrive across Pennsylvania, many families are discovering an alarming reality: without the Affordable Care Act’s enhanced premium tax credits, their monthly premiums are set to skyrocket.
For Pennsylvanians with disabilities, this sticker shock isn’t just about a higher bill. It threatens every part of daily life. Can they keep working? Can they afford the medications, therapies, and medical equipment that allow them to remain independent? Can they avoid choosing between health care and housing, food, or transportation?
The enhanced tax credits that make health insurance affordable for hundreds of thousands of Pennsylvanians expired on December 31, and the last day to enroll in coverage through Pennie is January 31. According to the state, 2026 premiums are approximately double what they were in 2025.
For people with disabilities, uncertainty is not an inconvenience; it is a serious risk. For example, take Melissa, a 42-year-old Pennsylvanian from Northumberland County. Melissa works part-time while managing a neurological disability that requires regular specialist visits, prescription medications, and physical therapy. She relies on coverage through Pennie, Pennsylvania’s health insurance marketplace, made affordable by the Affordable Care Act’s enhanced premium tax credits. Without those credits, Melissa’s monthly premium is projected to jump from just over $200 to more than $450 — an increase she simply cannot absorb. Her choices would be grim: drop coverage, skip critical care, or cut back on essentials like food and utilities.
Melissa is doing everything policymakers say they want people to do. She works. She budgets carefully. She uses the marketplace as intended. Yet without congressional action, she could lose the coverage that allows her to stay healthy enough to keep working at all. Without the tax credits, their premium would increase by hundreds of dollars a month—putting continued coverage out of reach.
As Misty Dion, the President of the Pennsylvania Council of Independent Living, recently explained, Affordable health care is the foundation of independence for people with disabilities. Medicaid and other coverage options provide the support that allows people to live in their communities instead of institutions. When health care and home- and community-based services become unaffordable or are underfunded, people lose not just coverage, but their ability to choose where and how they live and fully participate in community life.
Pennsylvania’s leaders, including many Republicans in Congress, have long supported policies that strengthen families, encourage work, and promote independence. Those values are reflected in landmark efforts like the Americans with Disabilities Act. Recently, three Republican Pennsylvania Members of the House of Representatives courageously requested a vote on extending these healthcare premium subsidies for three years, and voted for the extension, sending the bill to the Senate.
These policymakers recognized that a cliff would devastate their constituents who rely on premium subsidies. Extending the ACA’s premium tax credits is one of the most direct and effective ways to uphold those principles today. Affordable coverage allows people with disabilities to stay healthy enough to work, contribute to their communities, and live independently. Without it, medical debt rises, especially for those who already face higher out-of-pocket costs for prescriptions, durable medical equipment, and specialized care.
These tax credits don’t just help individuals; they also help Pennsylvania’s health care system. They reduce uncompensated care, stabilize the insurance marketplace, and prevent costs from being shifted onto taxpayers and hospitals. When coverage becomes unaffordable, people with disabilities are often left with only two options: rely more heavily on public programs or go without insurance altogether.
Neither option saves money. Delayed care leads to worse health outcomes and higher costs, driving up federal and state spending through Medicaid and uncompensated emergency care. Pennsylvania cannot afford that outcome, and neither can the families now anxiously looking for plans in their budgets.
Extending the ACA premium tax credits now will protect health, promote independence, and ensure that people with disabilities are not pushed out of the workforce and into crisis. Congress should act—before Pennsylvania families are forced off the coverage they depend on.
Amy Cline is the assistive technology and marketing/development coordinator with Roads to Freedom Center for Independent Living.