Maureen May

Last week, the Senate voted NOT to extend ACA subsidies, turning their backs on the American people and igniting a health care crisis that is already exploding at the bedside. Patients are already paying the price.

The enhanced Affordable Care Act premium tax credits are set to expire in just 11 days. If Congress allows this to happen — and given the Senate’s refusal to act this week, the danger is very real that it will — health insurance premiums will double for many working families in Pennsylvania. Households across the state will face increases of hundreds, and in many cases more than a thousand dollars, every single month.

This isn’t theoretical. It’s going to be here, all across Pennsylvania, on New Year’s Day, 2026.

Every one of us is going to suffer.

I’ve been a bedside nurse for more than 40 years and know that this is what will happen once the ACA tax credits are eliminated:

First, tens of thousands of people across Pennsylvania will lose coverage. Thousands already have. When people lose insurance, they don’t stop getting sick. They delay care. They will ration and skip medications and they hope problems will resolve on their own.

Most of the time, that doesn’t happen. Treatable conditions become emergencies. Those emergencies land in ERs and hospital beds, where care is more expensive and often unpaid. Patients wait longer for care, and hospitals, already struggling, are forced to absorb the costs of uncompensated care. That means hospitals have to do more with less, and the cost of care goes up for everyone else.

Patients suffer first. Hospitals suffer next. Communities suffer last, but they suffer the most.

If Congress does not renew the Enhanced Premium Tax Credits for Pennie, the Pennsylvania state marketplace, health care in Pennsylvania will be deeply destabilized. Hundreds of thousands of Pennsylvanians, including laboring mothers, trauma patients and people battling chronic or life-threatening illness, will be priced out of life-saving care.

Average premium increases will exceed 100%. A family of four may be forced to pay $800 to $1,400 more each month just to keep their coverage. Many simply won’t be able to. Pennie estimates 150,000 Pennsylvanians will lose insurance if Congress fails to act.

At the same time Congress is dithering over whether to extend ACA tax credits and maintain access to health care for millions of Americans, cuts to Medicaid have already been passed and are set to go into effect next year. Medicaid is a major source of hospital funding. Medicaid reimbursements already fall short of the cost of care, and those gaps are growing. So letting ACA tax credits expire now would remove coverage at the very moment hospitals are already absorbing financial losses, with more on the way.

That isn’t sound policy. It’s insanity.

We are already seeing the warning signs: Hospitals in the Philadelphia area are shutting down units, forcing patients to travel farther for critical care. Communities are losing maternity services. Behavioral health care, cancer care. Even ICUs are closing. And whole hospitals are being sold or consolidated.

This is how health care deserts are created — and once access is lost, it is incredibly difficult to restore.

Nurses across Pennsylvania are calling on Congress to act now to extend the Affordable Care Act premium tax credits — and to stop compounding the damage being done to our health care system.

This shouldn’t be about politics. It’s about access to care. It’s about hospital stability. And it’s about preventing a crisis that’s already taking shape.

Caregivers at the bedside know: The crisis isn’t coming — it’s here.

The patient — our entire health care system — is in acute distress. Nurses take an oath to do no harm. We are calling on Congress to do the same: Protect patients. Protect access to care. And stabilize the system before the damage becomes irreversible.

Maureen May, RN, is the president of the Pennsylvania Association of Staff Nurses and Allied Professionals, which represents more than 11,000 front line health care workers across the commonwealth including nurses and allied professionals at Butler Memorial Hospital.