The enhanced Affordable Care Act premium tax credits are set to expire on Wednesday, Dec. 31, 2025. Despite a last-minute push by a coalition of Republicans and Democrats in the House a move to extend those credits was not voted on before Congress adjourned for the holidays.
Congress is expected to debate the issue when it returns in January. It is unlikely the question will be resolved quickly meaning health insurance premiums will double for many working families in Pennsylvania. Households across the state — in rural areas and urban areas alike — will face increases of hundreds, and in many cases more than $1,000, every single month.
This isn’t theoretical. It’s New Year’s Day, 2026.
Every one of us is going to suffer.
I’ve been a bedside nurse for more than 40 years and know that this is what will happen once the ACA tax credits are eliminated.
First, tens of thousands of people across Pennsylvania will lose coverage. Thousands already have. When people lose insurance, they don’t stop getting sick. They delay care. They will ration and skip medications and they hope problems will resolve on their own.
Most of the time, that doesn’t happen. Treatable conditions become emergencies. Those emergencies land in emergency rooms and hospital beds, where care is more expensive, more dangerous and often unpaid. Patients wait longer for care and hospitals, already struggling, are forced to absorb the costs of more and more uncompensated care. That means hospitals have to do more with less, and the cost of care goes up for everyone else.
Patients suffer first. Hospitals suffer next. Communities suffer last, but they suffer the most.
If Congress does not renew the Enhanced Premium Tax Credits for Pennie, the Pennsylvania state marketplace, health care in Pennsylvania will be deeply destabilized. Hundreds of thousands of Pennsylvanians, including laboring mothers, trauma patients and people battling chronic or life-threatening illness, will be priced out of life-saving care.
Average premium increases will exceed 100%. A family of four may be forced to pay $800 to $1,400 more each month just to keep their coverage. Many simply won’t be able to. Pennie estimates 150,000 Pennsylvanians will lose insurance if Congress fails to act.
At the same time Congress is dithering over whether to extend ACA tax credits and maintain access to health care for millions of Americans, cuts to Medicaid have already been passed and are set to go into effect next year. Medicaid is a major source of hospital funding. Medicaid reimbursements already fall short of the cost of care, and those gaps are growing. So letting ACA tax credits expire now would remove coverage at the very moment hospitals are already absorbing financial losses, with more on the way.
That isn’t sound policy. It’s insanity.
We are already seeing the warning signs: Hospitals across the state are shutting down areas of care, forcing patients to travel farther for critical care. Communities are losing maternity services, behavioral health care, cancer care. Even intensive care units are closing – Pottstown Hospital just closed its ICU. And whole hospitals are being sold or consolidated.
This is how health care deserts are created — and once access is lost, it is incredibly difficult to restore.
Nurses across Pennsylvania are calling on Congress to to extend the Affordable Care Act premium tax credits — and to stop compounding the damage being done to our health care system.
This shouldn’t be about politics. It’s not about whether you are a Republican or Democrat. It’s about access to care. It’s about hospital stability. And it’s about preventing a crisis that we at the bedside know is already taking shape.
Frontline caregivers are sounding the alarm: The health care crisis in Pennsylvania and across the nation isn’t coming — it’s here.
The patient — our entire health care system — is in acute distress. Nurses take an oath to do no harm. We are calling on Congress to do the same. Protect patients. Protect access to care. And stabilize the system before the damage becomes irreversible.
This is a contributed opinion column. Maureen May is the president of the Pennsylvania Association of Staff Nurses and Allied Professionals, which represents more than 11,000 frontline nurses, techs, paramedics, pharmacists, social workers, and allied professionals across the commonwealth. The views expressed in this piece are those of its individual author, and should not be interpreted as reflecting the views of this publication. Do you have a perspective to share? Learn more about how we handle guest opinion submissions at themorningcall.com/opinions.
