Policy changes are expected to worsen access to care, raise costs, increase the uninsured rate, and push more Americans into medical debt, with Pennsylvania highlighted as a state that expanded Medicaid under the ACA facing particular strain.

Pennie, Pennsylvania’s health insurance exchange, has seen an unprecedented enrollment drop for 2026, with roughly a thousand enrollees lost daily early on, and subsidies lapsing driving about 85,000 people (one in five enrollees) to drop coverage and many remaining participants shifting to less comprehensive Bronze plans.

Legislation known as H.R. 1 would impose work and community engagement reporting for Medicaid enrollees, redefine disability criteria, and potentially exclude more people from Medicaid eligibility, according to experts.

Advocates are mobilizing communities and raising awareness, pursuing policy reversals or alternatives through ongoing activism by local groups and unions to pressure lawmakers.

Local reporting describes Pennsylvania’s health care system in crisis as subsidies are cut and Medicaid eligibility is tightened under H.R. 1, affecting access and affordability.

Personal stories illustrate the impact: a homecare worker facing a $300 monthly premium increase and medical debt, a caregiver worrying about reduced long-term care and Medicaid support, and a small-business owner with Type 1 diabetes who fears rising costs despite ACA protections.

Officials anticipate continued enrollment declines and rising uninsured or underinsured rates through the spring, as affordability concerns drive attrition from Pennie.