Roughly 1-in-5 Pennsylvania Obamacare plan enrollees dropped health coverage for 2026 due to "unprecedented cost increases," the state's online health insurance marketplace reported Monday.

Enrollment in the Affordable Care Act health insurance plans, also called Obamacare, totaled about 486,000 for 2026, with about 92,000 dropping their health plan. Terminations are expected to continue at elevated levels for the next several months.

Pennie, Pennsylvania's ACA marketplace, blamed the enrollment decline on the expiration of enhanced premium tax credits, which ended Dec. 31.

New enrollees in ACA plans totaled about 79,500, down 12% from a year ago.

"For many people, it's just unworkable from a financial perspective," Pennie Executive Director Devon Trolley said. "It's a steep hill to climb."

All ACA plans are eligible for government subsidies depending on enrollee income up to 400% of the federal poverty level. Enhanced tax credits were added in 2021, which mostly removed the 400% income cap, and the enhancements were renewed for three years starting in 2022.

Without the extra government subsidies, Pennie enrollees faced an average price increase of 102% to stay with their plan this year, "creating significant affordability challenges for many Pennsylvanians."

Indiana County resident Tony Gonzales, who is being treated for stage four cancer, said his monthly premium rose 57% to $368 this year, which he said was not as high as others had to pay.

"I had no choice but to pay the extra premium," said Gonzales, a college instructor in Cranberry Township, who picked up a part-time job to cover the higher premium. "For me, it's a matter of life and death."

Nearly 18% of Pennsylvania enrollees dropped coverage altogether, with terminations highest among older and rural Pennsylvanians and those with incomes just above Medicaid or above the new income cliff. Based on proportionate disenrollment, 15 of the top 20 counties were rural, where access to health care services is often already limited and rural hospitals often operate on thinner margins than urban providers.

ACA enrollees also shifted to less expensive plans this year to hold onto coverage. About 33,000 more Pennsylvanians enrolled in bronze plans compared to last year, a 30% increase. These plans have lower monthly premiums, but often have thousands of dollars more in out of pocket costs when medical care is needed.

Talks among top Senate negotiators to extend the enhanced premium tax credits collapsed last week, according to a Wall Street Journal report. Sens. Bernie Moreno, R-Ohio, and Susan Collins, R-Maine had proposed extending the enhanced subsidies for two years with some new restrictions on coverage, but those negotiations failed.

"It's effectively over," Moreno said Feb. 4.

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