Higher Uninsured Rate Looms over Future Pa. Health Care

February 26, 2026

Pennsylvania will have more uncompensated care without the extension of enhanced premium tax credits, state insurance leaders said this week.

During a House appropriations hearing Wednesday, Pennsylvania Insurance Commissioner Michael Humphreys and Pennie Executive Director Devon Trolley discussed recent enrollment trends on the state individual marketplace Pennie and concerns about uncompensated care.

“Having more uninsured individuals in Pennsylvania than we now have is a lose-lose for everyone,” Trolley said. “People don’t’ stop getting sick just because they don’t have coverage. It weakens our health care system, especially in rural areas, when care that had been fully reimbursed is now uncompensated care.”

Here are a few takeaways from the hearing:

Pennie saw significant coverage losses

Without enhanced premium tax credits, Pennie saw 104,000 Pennsylvanians end coverage, and about 20,000 dropped coverage in February alone, Trolley said.

Trolley said higher costs are putting pressure on consumers, who are adjusting household spending or switching to lower tier plans to stay covered. On average, the average premium increased 102 percent without the enhanced premium tax credits.

A higher uninsured population will be felt throughout the health system, increasing wait times in emergency rooms, driving up uncompensated care and medical debt, and leading patients to delay care.

“The long-term costs of the uninsured beg the question if we are now ultimately paying more,” Trolley said.

Humphreys noted a higher uninsured rate drives up costs for commercial insurance, due to a weaker risk pool of covered Pennsylvanians.

Access to maternal health coverage

Humphreys said there is work to be done to ensure access to maternal health care. The department released a report last year about what’s included in Pennsylvania coverage. He said up next is to ensure coverage for doulas, surrogacy, breast milk storage, and donated milk.

The report notes that Zuranolone, the first FDA‑approved fast‑acting oral treatment for postpartum depression, will be covered across insurers, but may require prior authorization or apply quantity limits.

Activity around pharmacy benefit managers

The Insurance Commission is preparing a study to evaluate the impact of spread pricing among pharmacy benefit managers and a potential $10.50 dispensing fee on overall market dynamics. The commission expects to provide the report, which is required by law, in the spring.

Also this spring, pharmacy benefit managers will be required to provide network adequacy reports. They also will be required to provide transparency reports later this year, identifying how much they pay affiliated and non-affiliated pharmacies, Humphreys said.

Watch the budget hearing online.