When Congress let “enhanced subsidies” lapse for the ACA market’s 24 million subscribers, prices surged. Millions of people dropped their plans as a result<\/a> of the increased costs.\u00a0<\/p>\n Next year, individuals who make less than $63,840 will pay no more than 10.22% of their income<\/a>, a relatively small increase, for a standard plan.\u00a0<\/p>\n Scassera earns more than that but isn\u2019t rich: She has never earned six figures. She\u2019s now one of the people who makes too much to receive a government subsidy \u2013 but not so much that she can easily absorb the rapidly increasing insurance costs.\u00a0<\/p>\n \u201cThe people that get screwed are the people that make just over the amount to get some help,\u201d Scassera said.<\/p>\n Why costs have increased so much<\/p>\n About two-thirds of the increase this year is due to the rapidly rising cost of healthcare, which continues to increase faster than salaries and inflation, according to Miranda Yaver, an assistant professor of health policy at the University of Pittsburgh.<\/p>\n \u201cHealthcare is really expensive and it’s becoming more expensive,\u201d she said. Even employer plans are going up by about 8% next year<\/a>, she said.\u00a0<\/p>\n New prescription drugs, like GLP-1s, are expensive, she said. Yaver takes medication for migraines and said her old drugs only cost $15 but the new, more effective drugs cost $800 per month. These costs get passed down in the form of higher premiums.<\/p>\n The second-largest factor: Congress not renewing the enhanced subsidies last year, according to Louise Norris, a health policy analyst for healthinsurance.org<\/a>. Nationally, ACA plans insure around 2.5 million fewer customers than they did last year<\/a>; about 12% fewer Pennsylvanians signed up for a Pennie plan in 2026. Many of those who dropped out were relatively healthy people who felt they could gamble on not getting sick this year, Norris said.\u00a0<\/p>\n \u201cInsurance companies knew that when coverage becomes less affordable, people \u2014 specifically healthy people \u2014 will tend to drop their coverage,\u201d Norris said.\u00a0<\/p>\n That has left the ACA market with a disproportionate number of people, like Scassera, who aren\u2019t sure if they can afford the large increases, but also aren\u2019t healthy enough to feel comfortable dropping their insurance entirely.\u00a0<\/p>\n \u201cWe’ve created an insurance environment that makes it untenable for healthier people to feel like they’re getting their money’s worth,\u201d Yaver said.<\/p>\n A spokesperson for Highmark confirmed that it is facing similar headwinds as the rest of the industry. \u201cOur 2027 ACA rates reflect rising medical and pharmacy costs of our Pennsylvania members, continued high utilization rates, and the expiration of the Individual Market\u2019s enhanced premium tax credits,\u201d the statement said.<\/p>\n Many of those receiving a subsidy responded by choosing less generous insurance plans last year, Norris said. The number of people enrolled in Bronze plans, the lowest tier, increased by a third last year, Norris said. So, they are often paying more on premiums, because of cost increases, and more out-of-pocket health care expenses, because of their reduced benefits.<\/p>\n The large cost increases the last two years are especially acute for people who don\u2019t receive a subsidy, Norris said. \u201cHow long can people who are not getting a subsidy continue to absorb\u00a0double-digit annual rate increases?\u201d<\/p>\n Scassera said she never would have quit her social work job and started her own therapy business if she knew the cost of buying insurance on her own would nearly double in five years. \u201cNo way,\u201d she said.<\/p>\n Sweating, freezing \u2014 but not going to the ER<\/p>\n Scassera stopped going to eye doctors and puts off her X-rays at the dentist for as long as she can get away with. She sometimes finds cheaper drugs online and pays for them out-of-pocket because they cost less than what she would pay under her insurance.<\/p>\n Last summer she became inexplicably sick with a fever and chills that were so severe she had to call her sister to come over and change her thermostat because she couldn\u2019t pull herself off the couch. \u201cI would go from sweating and laying in cold water to freezing and having 10 blankets,\u201d she said.<\/p>\n She started having breathing problems but didn\u2019t want to go to the emergency room because of the $500 out-of-pocket copay for an unannounced visit. So she saw a physician\u2019s assistant who, Scassera said, told her she could go home and return the following week if she wasn\u2019t better.<\/p>\n But Scassera thought she was dying and started crying, which finally prompted her provider to order some blood tests that came back with many abnormalities. Scassera was finally admitted to Forbes Hospital. The sudden onset of her extreme symptoms finally led an infectious disease specialist to diagnose her with anaplasmosis.\u00a0<\/p>\n The tick-borne disease is less common and less well understood than Lyme disease, but treated by the same medicine, doxycycline. It\u2019s fatal in about one in 200 cases, and risks increase when left untreated. \u201cI could have died if I hadn’t pushed to get that extra blood work,\u201d Scassera said.<\/p>\n She took antibiotics and felt better after two weeks. But Scassera said pain in her bladder, stomach and joints in January reminded her of the pain from anaplasmosis. Her search for answers has racked up thousands of dollars in expenses, including a cystoscopy, a pelvic ultrasound and a $1,900 test for rheumatoid arthritis that turned out to be out-of-network, despite being performed at an in-network hospital.<\/p>\n She\u2019s trying to decide whether to go through with a minor surgical procedure on her thumbs that doctors believe will help relieve joint pain there \u2013 but also set her back more than $1,500 after insurance.<\/p>\n She has thought about enrolling in a cheaper health care plan but said she spends days trying to research this every year and finds it hard to understand how much her out-of-pocket expenses would be after copays and coinsurance.<\/p>\n \u201cI have a master’s degree and 30 years experience, and if I am not getting tests and procedures that are recommended because I feel like it’s too expensive,\u201d she said, \u201cwhat about all the people that don’t make as much as me? What are they not doing?\u201d<\/p>\n Scaserra\u2019s primary care doctor recently brought up the possibility of seeing a specialist in chronic Lyme disease.\u00a0<\/p>\n \u201cShe thinks I should go to functional medicine, which is of course, totally out-of-pocket,\u201d Scassera said. \u201cIt’s very frustrating. Just makes me want to give up.\u201d<\/p>\n What can be done?<\/p>\n State Rep. Arvind Venkat, D-McCandless, a medical doctor and a member of the Pennie board, said he is seeing an increasing number of patients who show up in the emergency room worried about what it will cost. He\u2019s pushing for a bill in Harrisburg that would give tax credits to small businesses that reimburse employees for what they spend on Pennie plans.<\/p>\n Venkat said he believes healthcare costs are on the ballot this year, particularly in federal races. \u201cWhat we can do at the state level is important. It’s more than just at the margins,\u201d he said. \u201cBut it is not nearly as much as again making it a federal priority to make sure that everyone has access to affordable health insurance.\u201d<\/p>\n Yaver, the Pitt professor, believes the federal government needs to take a more active role in negotiating drug prices. \u201cAmericans are rationing their prescription drugs due to cost and insurers are jacking up the cost of premiums in part due to pharmaceutical costs,\u201d she said. \u201cAnd so we’re kind of getting squeezed in every direction and there is a solution.\u201d<\/p>\n Norris said the new Congress after the election in November could bring back subsidies that would stabilize the healthcare exchanges. \u201cAnything they do that makes coverage more affordable will bring in healthier enrollees and help to stabilize the program,\u201d she said. \u201cSo that’s something that regulators and lawmakers are well aware of but there’s also a price tag associated with it.\u201d<\/p>\n When Scassera was raising her three kids, she would often work extra jobs selling copies of the Sunday Pittsburgh Post-Gazette at Steelers games for $1 to supplement her salary as a social worker. She got to keep 50 cents, which helped pay for things like new shoes for the kids every year.<\/p>\n Scassera started her own business as a therapist five years ago, after her kids were grown up. Her business gave her a chance to finally earn enough money to save for retirement. But it also allowed her to provide higher quality care to her patients. She believes she can give better care to five patients per day than the eight patients that companies often require of their therapists.<\/p>\n Healthcare costs, though, threaten to undermine both of those goals. \u201cI will probably have to try to go back to working for somebody,\u201d she said. \u201cAnd obviously making less money.\u201d<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/us-pa\/wp-content\/uploads\/2026\/10\/20261006-ACA-healthcare-increases-04.jpg\")
April Scassera, 54, stands for a portrait at home in Monroeville. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/us-pa\/wp-content\/uploads\/2026\/10\/20261006-ACA-healthcare-increases-10.jpg\")
April Scassera, 54, sits for a portrait in a swing in her Monroeville yard. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n