Thousands of Pennsylvanians have bailed on coverage through Pennie this year as 2026 premiums spiked, leaving many Philadelphia-area families doing brutal math between medical bills, groceries and rent. The loss of temporary federal subsidies combined with sharp insurer rate hikes has delivered sudden sticker shock to people who had been paying little or nothing for plans in recent years. Local advocates warn the fallout could bring more unpaid hospital bills and worse health outcomes for people who end up uninsured.
Statewide numbers and who is leaving
According to Pennie, as of April 9 the exchange counted about 462,751 enrollees, and roughly 45,000 customers had cancelled coverage since open enrollment closed on Jan. 31. Those post-enrollment terminations come on top of roughly 85,000 people who dropped plans during open enrollment, leaving Pennie with more than 130,000 cancellations when combined, the agency says.
Philadelphia households hit hardest
Philadelphia has been especially hard hit. Reporting shows average monthly premiums in the city jumped by about $137, roughly 116 percent higher than last year, a spike that pushed many people to downgrade plans or walk away from the market entirely, as Axios reported. The price shock nudged many enrollees toward bronze plans with higher deductibles, increasing the risk that even those who stay insured will face large out-of-pocket costs.
A national pattern
A KFF follow-up survey of 2025 marketplace enrollees found that roughly one in 10 had dropped Marketplace coverage and become uninsured after the enhanced federal credits expired, and many others said costs had become “a lot higher.” Those national findings mirror what Pennie and local health advocates are now seeing in Pennsylvania: downgrades to bronze plans and sharp spikes in cancellations.
Advocates warn of medical debt
"We’re very concerned those people will be at risk of medical debt," Joanna Rosenhein of the Pennsylvania Health Access Network told WHYY. Advocates say that without new state or federal help, people who drop coverage are likely to delay care, and that will push costs onto hospitals and clinics that provide uncompensated treatment.
Federal budget pressure
The White House’s FY2027 budget request would cut discretionary funding for the Department of Health and Human Services by about $15.8 billion, a 12.5 percent reduction from the 2026 enacted level, which could tighten the federal safety net for states trying to plug gaps. The administration’s request is only an opening position for Congress, but health care groups warn the proposal would make it harder for states to step in if federal subsidies remain unavailable; see the White House for details.
State options and what is at stake
Pennie says it is monitoring terminations and that attrition is expected to continue through the spring. The exchange has urged lawmakers to consider a state affordability program to replace lost federal help. Per a release from the governor’s office, Gov. Josh Shapiro included $50 million last year to help preserve Pennie coverage, a pot advocates say could blunt the worst outcomes if federal relief does not return.
What to watch next
Watch enrollment counts, premium-payment terminations and hospital unpaid-care reports over the coming months. Those metrics will show whether the early cancellations turn into a lasting rise in the uninsured. For now, advocates and legislators are focused on whether state funding or congressional action on premium tax credits materializes before more families go without coverage.
People who lose employer coverage or experience qualifying life events may still be able to enroll outside the annual window, and community assisters remain available to help residents weigh options. Tracking these shifts will matter for city health providers, local lawmakers and the families who rely on the marketplace for their care.
