With subsidies off the table, a Lancaster couple faces a premium surge of roughly 175%.
Steve and Brenda Horst run a small miniature golf business in Lancaster that brings in about $100,000 annually.
Brenda Horst, 58, is their only full-time employee, which means they can’t obtain health insurance through the business.
Last year, their health insurance premium was $1,600 per month, offset by roughly $800 per month in Affordable Care Act subsidies.
This year, those subsidies are no longer available.
The Senate recently blocked a bill that would extend the subsidies. Unless an unexpected late-year deal emerges in a deeply divided Congress, the subsidies will expire at year’s end.
That vote marked the last shred of hope for the Horsts to keep premiums at more manageable levels.
The reality now is stark: their premium will jump to about $2,200 per month, a rise of around 175%, accompanied by a higher deductible.
“That’s more than a quarter of our pretax income,” said Steve Horst, 57. “We can’t afford this, and we don’t know what to do. We have a $1,500 mortgage. That premium is more than our house payment.”
For months, Americans have been inundated with headlines warning of steep premium increases if Congress fails to extend the Enhanced Premium Tax Credits.
The fierce clash between Democrats, who advocated extending the credits, and Republicans, who argued the system is prone to fraud and would fuel federal spending, culminated in a government shutdown and now a looming financial cliff for thousands like the Horsts.
“I’m thinking I might cancel the insurance,” Steve Horst said. “If you’re paying $1,800 a month and you could still face a $12,000 to $15,000 deductible, you start wondering if it’s worth it. Why should I pay that? I could take that $1,800 a month and put it in the bank and hope for the best. It’s either that or we’ll be totally broke.”
Pennie, Pennsylvania’s ACA marketplace, projects that as many as 150,000 people could lose health coverage due to the expiration.
Since 2021, the enhanced tax credits have provided about $600 million annually in subsidies to Pennsylvania residents, keeping premiums at or below 8.5% of income. With the credits gone, Pennie enrollees are anticipated to see an average premium increase of about 102%.
In central Pennsylvania, rate hikes outpace the rest of the state, affecting all income and age groups but hitting higher earners aged 60 and older especially hard, according to data from the Kaiser Family Foundation.
Steve Horst criticized the political deadlock: “The current administration highlights the issue, but for 20 years Congress has dragged its feet. There was no sense of urgency, so they just kept ignoring it. Medical costs have driven innumerable people to the brink. Isn’t it true that about two-thirds of all bankruptcies stem from medical expenses or illness-related work loss?”
Estimates from the American Journal of Public Health indicate that roughly two-thirds of U.S. bankruptcies are due to medical reasons.
Horst has contacted his lawmakers, emailing Sen. John Fetterman and Rep. Loyd Smucker. KFF Health News notes that 57% of ACA Marketplace enrollees live in Republican congressional districts.
Smucker’s office responded, attributing the situation to corruption and waste in the system, though Horst argues that normal people shouldn’t bear the burden. He admits he’s considering dropping insurance, a choice he finds extraordinarily risky at age 57.
But here’s where it gets controversial: the debate over subsidies pits urgent financial relief for individuals against concerns about system integrity and federal spending. And this is the part most people miss: without broad, sustainable reforms, the risk isn’t just higher premiums—it’s that essential coverage becomes unaffordable for many and the safety net frays at the edges. What’s your stance on subsidies and healthcare reform? Should lawmakers prioritize immediate relief for families like the Horsts, or pursue longer-term structural changes even if they take more time to implement?
