How much more are ~440,000 PENNSYLVANIA ACA enrollees *really* paying this year due to Trump/GOP policies?

IMPORTANT: See the original post in this series for an explanation of the methodology.

Regular readers know that I've been obsessing over the massive increases in both gross as well as net premiums for ACA health insurance policy enrollees being caused by the combination of Congressional Republicans allowing the enhanced federal tax credits to expire as well as other Trump Regime policy changes for well over a year and a half now.

I've written countless analyses of how much both gross and net premiums skyrocketed from 2025 to 2026 across different states, different income levels and various other demographics...and last week it was revealed that over 3 million ACA exchange enrollees had already been priced out of the market as of April, with the number almost certain to climb further throughout the rest of 2026.

As I've repeatedly warned, however, the increases in premium costs (whether gross or net) are only half the story. The other big shoe which is dropping this year is increased out of pocket costs as millions of the ~19.2 million or so remaining enrollees as of April have been forced to downgrade their coverage to avoid (or at least minimize) those massive premium spikes.

In most cases this means moving to plans with higher deductibles, higher co-pays & higher coinsurance costs. In many cases this has also included moving to plasn with worse networks, referral requirements to see specialists and so on.

With that in mind, that's exactly what I've decided to set out to do: Calculate the average year over year increase not just in net premiums (that is, how much more ACA enrollees are having to pay each month) but also the year over year change in average out of pocket costs.

Let's look at PENNSYLVANIA:

Here's a look at ACA exchange plan selections during Open Enrollment by household income level this year vs. last.

Thanks, presumably, in no small part to Premium Alignment pricing, Pennsylvania actually bucked the national trend and saw the number of people selecting policies during Open Enrollment actually increase (if only slightly) this year; while enrollment below 100% FPL and over 400% FPL still plummeted by high double digits due to subsidy eligibility being stripped away from thousands of people, this was canceled out by increases from 100 - 150% and 300 - 400% FPL (though I suspect a chunk of each are actually cases of households who normally earn < 100% or > 400% FPL projecting incomes over/under the cut-off points who are now desperately doing whatever they can to make sure they don't fall outside the subsidy eligibility range):

UNFORTUNATELY, the news since the end of Open Enrollment isn't so positive: The number of effectuated enrollees in Pennsylvania was down 5.2% year over year by May, and as of June it's continued to drop. Year over year, there are ~35,000 fewer Pennsylvanians enrolled in ACA coverage this month than there were a year ago, or 7.3% fewer.

Onto the main analysis:

Here's total Open Enrollment plan selections for both 2025 & 2026 broken out by Actuarial Value (AV) category. The first table is based on official metal level tiers, but it's the second table which is critical, since a huge chunk of ACA enrollees are usually enrolled in CSR Silver plans (which include Cost Sharing Reduction assistance). CSR assistance dramatically boosts the AV of Silver plans up to Platinum levels in most cases.

Again, thanks to Premium Alignment pricing, while enrollment in high CSR Silver plans have dropped substantially, this has been shored up somewhat by enrollment in Gold plans holding steady (they're actually up slightly), while Platinum plan enrollment doubled (it was only a few hundred to begin with, however). Bronze enrollment, naturally, jumped by a full third, although enrollment in Catastrophic plans was actually cut in half, which is a bit surprising (the only explanation I can think of is that some of the carriers which offered Catastrophic plans last year discontinued doing so this year).

Overall, the average Actuarial Value has dropped slightly from 77.9% to 76.2%:

By combining these numbers with the average gross premiums per enrollee I'm able to calculate an estimate of the average total medical expenses each enrollee racks up each year assuming an 80% average Medical Loss Ratio (as I stated in the original post, this can vary widely by carrier and year, so should be considered a very broad average only), which looks like so:

Overall, average net premiums for the ~440,000 were still enrolled as of this month still went up over 34% on average, from $187/mo to $251/mo. On the one hand, this means they're paying over $750 more in premiums per year. On the other hand, that's actually a lower spike than in most states so far, so...

Meanwhile, estimated out of pocket expenses went up by a similarly "modest" 25%...for a total increase from around $4,000 last year to over ~$5,200 per enrollee this year...or over $1,200 more apiece.

In addition, based on KFF's net data, average deductibles also increased by ~25% to ~$3,300 for single coverage this year, and the maximum (theoretical) out of pocket cut-off for all ACA enrollees went up by over 15% this years as well, to $10,600 for single coverage.

Next up: RHODE ISLAND.