April Scassera, 54, opened a letter from Highmark last month and learned her monthly health insurance premiums were increasing to $887.
The 25% increase follows a 19% increase the year before and would put her total healthcare costs above $10,500 before any out-of-pocket expenses.
After last year’s increase, Scassera, a therapist from Monroeville, considered dropping her insurance entirely. “Fortunately, I didn’t,” she said.
She began having unusual pain in her abdomen and joints in January that she thinks is linked to anaplasmosis, a severe tick-borne illness she contracted in 2025. Just after she finished paying off last year’s hospital bill earlier this year, she had to pay more than $1,900 for a test to see if the new pain she was experiencing was arthritis. It was not.
She’s now rationing her tests and procedures as she tries to find an explanation for what’s ailing her. She canceled an MRI recently because it required a $500 copay. She already cut out her dental and vision insurance.
Scassera is one of more than 2 million Americans who purchased a healthcare plan from an Affordable Care Act exchange and have to pay the full cost of double-digit premium increases for two years in a row. (In Pennsylvania, these plans are purchased on the Pennie exchange.)
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 of the increased costs.
Next year, individuals who make less than $63,840 will pay no more than 10.22% of their income, a relatively small increase, for a standard plan.
Scassera earns more than that but isn’t rich: She has never earned six figures. She’s now one of the people who makes too much to receive a government subsidy – but not so much that she can easily absorb the rapidly increasing insurance costs.
“The people that get screwed are the people that make just over the amount to get some help,” Scassera said.
Why costs have increased so much
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.
“Healthcare is really expensive and it’s becoming more expensive,” she said. Even employer plans are going up by about 8% next year, she said.
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.
The second-largest factor: Congress not renewing the enhanced subsidies last year, according to Louise Norris, a health policy analyst for healthinsurance.org. Nationally, ACA plans insure around 2.5 million fewer customers than they did last year; 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.
“Insurance companies knew that when coverage becomes less affordable, people — specifically healthy people — will tend to drop their coverage,” Norris said.
That has left the ACA market with a disproportionate number of people, like Scassera, who aren’t sure if they can afford the large increases, but also aren’t healthy enough to feel comfortable dropping their insurance entirely.
“We’ve created an insurance environment that makes it untenable for healthier people to feel like they’re getting their money’s worth,” Yaver said.
A spokesperson for Highmark confirmed that it is facing similar headwinds as the rest of the industry. “Our 2027 ACA rates reflect rising medical and pharmacy costs of our Pennsylvania members, continued high utilization rates, and the expiration of the Individual Market’s enhanced premium tax credits,” the statement said.
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.
The large cost increases the last two years are especially acute for people who don’t receive a subsidy, Norris said. “How long can people who are not getting a subsidy continue to absorb double-digit annual rate increases?”
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. “No way,” she said.
Sweating, freezing — but not going to the ER
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.
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’t pull herself off the couch. “I would go from sweating and laying in cold water to freezing and having 10 blankets,” she said.
She started having breathing problems but didn’t want to go to the emergency room because of the $500 out-of-pocket copay for an unannounced visit. So she saw a physician’s assistant who, Scassera said, told her she could go home and return the following week if she wasn’t better.
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.
The tick-borne disease is less common and less well understood than Lyme disease, but treated by the same medicine, doxycycline. It’s fatal in about one in 200 cases, and risks increase when left untreated. “I could have died if I hadn’t pushed to get that extra blood work,” Scassera said.
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.
She’s trying to decide whether to go through with a minor surgical procedure on her thumbs that doctors believe will help relieve joint pain there – but also set her back more than $1,500 after insurance.
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.
“I 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,” she said, “what about all the people that don’t make as much as me? What are they not doing?”
Scaserra’s primary care doctor recently brought up the possibility of seeing a specialist in chronic Lyme disease.
“She thinks I should go to functional medicine, which is of course, totally out-of-pocket,” Scassera said. “It’s very frustrating. Just makes me want to give up.”
What can be done?
State Rep. Arvin 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’s pushing for a bill in Harrisburg that would give tax credits to small businesses that reimburse employees for what they spend on Pennie plans.
Venkat said he believes healthcare costs are on the ballot this year, particularly in federal races. “What we can do at the state level is important. It’s more than just at the margins,” he said. “But it is not nearly as much as again making it a federal priority to make sure that everyone has access to affordable health insurance.”
Yaver, the Pitt professor, believes the federal government needs to take a more active role in negotiating drug prices. “Americans are rationing their prescription drugs due to cost and insurers are jacking up the cost of premiums in part due to pharmaceutical costs,” she said. “And so we’re kind of getting squeezed in every direction and there is a solution.”
Norris said the new Congress after the election in November could bring back subsidies that would stabilize the healthcare exchanges. “Anything they do that makes coverage more affordable will bring in healthier enrollees and help to stabilize the program,” she said. “So that’s something that regulators and lawmakers are well aware of but there’s also a price tag associated with it.”
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.
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.
Healthcare costs, though, threaten to undermine both of those goals. “I will probably have to try to go back to working for somebody,” she said. “And obviously making less money.”
Oliver Morrison is the health and environment reporter at Pittsburgh’s Public Source and can be reached at oliver@publicsource.org.
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