Pittsburghers and millions of Americans scramble for health insurance as ACA subsidies head for expiration

Peregrine Kelly, owner of Inner Prism Counseling, a Wilkinsburg-based psychotherapy practice, stands for a portrait, Thursday, Dec. 11, 2025, at their home office in Upper St. Clair. As the statemate in Washington over federal health insurance subsidies dragged on this fall, they used the money budgeted for their employees’ retirement plan to instead offer private health insurance. (Photo by Stephanie Strasburg/Pittsburgh’s Public Source) As workers and employees across the country seek insurance solutions beyond the fading subsidies, one local business owner pulled retirement plan funds to support private insurance options. “Pittsburgh’s Public Source is an independent nonprofit newsroom serving the Pittsburgh region. Sign up for our free newsletters.”

by Venuri Siriwardane, Pittsburgh’s Public Source

Peregrine Kelly, the owner of a Wilkinsburg-based psychotherapy practice, made an agonizing choice as the stalemate in Congress over federal health insurance subsidies dragged on this fall: They used the money budgeted for their employees’ retirement plan to instead offer private health insurance.

Kelly said President Donald Trump’s 2025 budget reconciliation law — known as the “One Big Beautiful Bill Act” — put them in that difficult position. Unless Congress extends subsidies before they expire at the end of the year, the bill will sunset the Biden-era enhanced premium tax credits that made Affordable Care Act (ACA) marketplace health insurance significantly more affordable, among other sweeping cuts to federal funding for health care programs. Without the extra help, consumers are experiencing sticker shock during open enrollment, which started Nov. 1 and lasts through Jan. 31. Faced with higher premiums, some said they’ll shop for a cheaper plan — which typically results in higher out-of-pocket costs and a more restrictive provider network — or forgo health insurance altogether, according to a national poll by KFF, a San Francisco-based health policy research organization. Pennie, the state’s Health Insurance Exchange Authority, is grappling with an increase in calls to its customer service center as Pennsylvanians seek answers about what they can expect to pay for coverage in 2026. “Most all understand that … prices are increasing” due to the expiring tax credits, spokesperson Kelsey Cameron wrote in an email to Public Source. Amid customer confusion and anxiety, Pennie extended the enrollment deadline for coverage starting Jan. 1. Enrollees now have until Dec. 31, but the authority won’t officially announce the extension until after the original Dec. 15 deadline “to avoid further confusion this year,” Cameron said. She urged customers to still enroll by Dec. 15 “to allow enough time to receive their insurance materials by New Year’s Day and make sure they have the continuity of care.” A group providing assistance to Pennsylvania health care consumers has also seen a spike in calls to its helpline. Callers are confused, angry and extremely worried, said Shana Jalbert, director of communications for the Pennsylvania Health Access Network, which has seven staffers fielding help requests throughout the state, including one in Pittsburgh. “We’re hearing, to be honest, panic,” Jalbert told Public Source. “People are really concerned about keeping their coverage. And for people who have a health condition and need regular care, they’re really scrambling to figure out how they’re going to be able to … pay those [higher] monthly costs that they weren’t expecting.” If the tax credits expire, the average cost increase per plan member, per month in Allegheny County will be $125, according to Pennie. It reported a 20% decrease in new enrollees so far from the 2025 open enrollment period that started last year. “For every one new enrollment, two existing enrollees have terminated coverage in the first five weeks of open enrollment,” the authority stated on its website. Kelly previously had staff insured through Pennie, but that’s no longer a viable option. They are furious over the health risks some vulnerable Pennsylvanians are taking on as they buy less-comprehensive coverage or choose to go without insurance so they can afford other necessities. It’s why they made sure their staffers wouldn’t be among them. “Some of my employees have chronic conditions and the uncertainty over the future of marketplace plans made me feel an obligation to secure good, stable, affordable insurance for them,” Kelly said. If they hadn’t acted quickly, staffers may have left the practice for jobs offering employer-sponsored group plans, they added. “The government is playing politics with people’s lives,” Kelly said. “Health care literally keeps people alive, as well as helping them function physically, mentally and emotionally. We can’t go without it.”

‘I’m angry, but determined’

Five years ago, about 12 million people selected an ACA plan. Enhanced tax credits were introduced the following year and four years later enrollment had doubled to over 24 million. Today, millions of people benefit from the enhanced subsidies. Small businesses have benefited, too. Kelly, a licensed social worker and former lawyer, launched Inner Prism Counseling in August. The practice initially helped employees pay for insurance through a Qualified Small Employer Health Reimbursement Arrangement. It allows an employer with 50 staffers or less to set aside a fixed amount of money each month that employees can use to purchase individual health insurance, usually through the marketplace.

Kelly had planned to offer group health benefits within the next year anyway, but expected to have enough time to shop around for competitive quotes from insurers such as UPMC Health Plan. But they realized that would be impossible when Democrats failed to secure an extension of the enhanced ACA subsidies during the recent government shutdown fight, despite making the expiring subsidies central to their objections to the Republican-proposed spending bill. Kelly scrambled last month to “get some workable quotes” from Gusto, the practice’s payroll provider, and tapped into funds for employees’ 401(k) plans to pay for the group plan. “I’m not even sure the practice can 100% afford group health insurance at this point,” they said. Though staffers are working without an employer-sponsored retirement plan for the foreseeable future, they gave Kelly “extremely positive feedback” about their decision. “The recognition that health insurance was more important was pretty universal at our practice,” they said, noting they’re “still going to try to offer a retirement plan” as soon as possible. “I’m angry, but determined,” Kelly said. “And I think we’ll get there.”

Don’t wait on federal action to enroll

If the enhanced premium tax credits expire, psychotherapist Jennifer Matesa’s monthly premium for her gold-tier EPO would jump from $257 to more than $1,000. “It would really stretch my budget,” said the 61-year-old independent contractor from Friendship. “Why the hell are they getting rid of these tax credits for people like me who work to improve Americans’ mental health?” she asked, noting she sees patients “who are living with disability, depression and anxiety, in part because of the shenanigans that are going on in Washington.”

Matesa called Pennie in search of guidance. She spoke with weary, but “unfailingly courteous” customer service agents “at the end of their workday after they spent the entire day” trying to help worried consumers. She hasn’t gotten the answers she needs to make informed budgeting decisions before renewing her coverage. The Pennsylvania Health Access Network urged consumers not to assume the worst as the media reports on skyrocketing premiums. “These cost increases for plans are averages,” Jalbert pointed out. She reminded enrollees that, while the enhanced premium tax credits are due to expire, other tax credits and types of assistance are still available. People should still shop the marketplace and explore the prices that reflect their unique situation, which is influenced by age, income, household size and other factors. She also urged those who’ve downgraded to Bronze-tier plans or chosen to forgo insurance to “keep an eye on” news reports and communications from Pennie in case Congress extends the tax credits or enacts another solution. “You can still … change your mind if circumstances change” during open enrollment, she added.

“Enrolling now ensures coverage for all of 2026 and if something changes, they will have time to change or enroll in a new plan.” Kelsey Cameron

Asked how Pennie will handle a potential congressional action that would extend the tax credits, Cameron said it will need time to update its system, but “will work to update enrollee accounts with their new tax credits and provide them plenty of time to shop and change their plans, as soon as possible.” But “we encourage consumers to not wait on federal action,” she added. “Enrolling now ensures coverage for all of 2026 and if something changes, they will have time to change or enroll in a new plan.” If Congress lets the tax credits expire, Jalbert predicts severe public health consequences in Pennsylvania and across the country. More people will “go uninsured or get a level of insurance that doesn’t quite meet their needs or would cause them to delay or avoid care,” she said. Hospitals and other provider organizations will also absorb the cost of unpaid bills, which will disproportionately impact struggling facilities, many of which are in rural areas, she added, noting cuts to Medicaid will compound the problem. A report from The Commonwealth Fund, a foundation focused on health care, and researchers at George Washington University projected that nearly 340,000 U.S. jobs will be lost as loss of income forces providers to reduce their workforces. It also estimates that 5 million people will become uninsured in 2026 if tax credits expire.

Senate rejects competing partisan proposals

The tax credits have been at the heart of fierce discussions in Congress in recent weeks, with Democrats insisting that they be extended to help Americans with rising health costs. On Thursday, the Senate rejected two partisan health bills on the expiring subsidies, essentially guaranteeing that millions of Americans will see a steep rise in costs at the beginning of the year. The Democratic bill would have extended the subsidies for three years, while the GOP alternative would have replaced the subsidies with new health savings accounts. Congressional Republicans have sought for more than a decade to replace the ACA —  former President Barack Obama’s signature law — also known as Obamacare. Legislation by U.S. Sen. Bill Cassidy, R-Louisiana, the chairman of the Senate Health, Labor, Education and Pensions Committee, and Sen. Mike Crapo, R-Idaho, the chairman of the Senate Finance Committee, would have replaced the subsidies with new health savings accounts for enrollees making less than 700% of the federal poverty level who pick lower-cost, higher-deductible insurance plans. The Cassidy and Crapo bill also included new language limiting the use of ACA money for abortion — a dealbreaker for moderate Democrats who say they would have been willing to negotiate on the issue. Health analysts warned that the plan won’t do much to help lower-income ACA enrollees who rely on subsidies to afford their monthly insurance fees. Sen. Ron Wyden, D-Oregon, his party’s top Senate Finance Committee member, said the GOP proposal “leaves middle-class Americans saddled with sky-high premiums, and Big Insurance makes out like bandits by selling junk plans to families that desperately need health coverage.” “Instead of working with Democrats to stop this health cost crisis, Republicans are selling snake oil,” Wyden said.

Resources for Pennie enrollees

• Pennie is providing updates on changes due to federal law here.
• The Pennie Help Center offers free support via phone, chat or message. Call 1-844-844-8040 to reach a customer service representative or 1-844-844-4440 to reach a Pennie-certified insurance broker or an assister.
• Here’s Pennie’s deep dive into affordability in 2026, including data showing the average cost increase per county.
• Here’s a federal guide on how to use tax form 1095-A during open enrollment. Enrollees receive the form in the mail each year by mid-February.
• The Pennsylvania Health Access Network provides free help to those seeking to understand the state’s health insurance marketplace and enroll in coverage. Call or text its helpline at 877-570-3642 or fill out this form. Assistance is also available in Spanish.
• The New York Times has a guide on “how to shop for Obamacare when subsidies are in limbo.”
• A KFF calculator estimates how much you would pay in premiums with or without ACA enhanced premium tax credits.
• A Georgetown University guide includes information about a variety of Trump administration policies affecting ACA access, affordability and process.

Correction (12/12) : An earlier version of this story inaccurately reported Jennifer Matesa’s current health insurance premium.

Venuri Siriwardane is the health and mental health reporter at Pittsburgh’s Public Source. She can be reached at venuri@publicsource.org or on Bluesky @venuri.bsky.social. The Associated Press contributed reporting.  The Jewish Healthcare Foundation has contributed funding to Public Source’s health care reporting. This story was fact-checked by Rich Lord. This article first appeared on Pittsburgh’s Public Source and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.