The expiration of the Affordable Care Act tax credits that help Americans afford health care through their state marketplaces would wreak havoc on Pennsylvania’s health care landscape and further burden nurses already dealing with staff shortages and burnout, said registered nurse Peggy Malone.
Half a million Pennsylvanians and 20 million people nationwide stand to see their health insurance premiums more than double in 2026 as congressional Republicans have so far refused to extend the tax credits that expire at the end of December. Congress initially enacted the credits in 2021, when Americans were losing jobs and their health insurance in the early days of the COVID pandemic.
Millions of Americans could lose coverage in the coming years if Congress allows the credits to expire, according to an analysis from the Center on Budget and Policy Priorities, a progressive think tank that analyzes federal policy.
“I think it’s a real strong possibility that they will let these lapse,” said Malone, a registered nurse for 37 years and an executive board member of the Pennsylvania Association of Staff Nurses and Allied Professionals union. “We keep pressuring the politicians and Congress, and we keep pushing forward, saying, ‘This can’t happen.’ But you know the reality is that it really could, and it will be devastating for this country.”
As Pennsylvanians lose their health coverage due to the expiration of the tax credits or purchase cheaper plans that cover fewer services, they could be forced to forego preventative health care and turn to emergency rooms for health issues that have gone untreated, Malone said. Malone recently lost her job at Crozer-Chester Medical Center in Delaware County after it closed in May; she now works per diem at Jeffrey Einstein Philadelphia Hospital.
“What we’re going to see is that people don’t go to the doctors for routine checkups and routine visits,” she said. “What is going to happen is these people are going to wait til they’re very sick, and they’re going to end up in the already overcrowded emergency rooms.”
That added burden on hospitals comes at a time when Americans are also losing Medicaid coverage after congressional Republicans slashed about $1 trillion from Medicaid as part of their One Big Beautiful Bill Act that President Donald Trump signed into law in July. That, Malone said, means hospitals, particularly those that heavily rely on Medicaid funding, are at risk of closing across the state. Twenty-five rural hospitals in Pennsylvania could shutter due to the Medicaid cuts, according to Gov. Josh Shapiro’s administration.
“What’s going to happen is that these hospitals who serve the underprivileged communities, who rely heavily on this funding, are going to be forced to close, and if not complete closure, they’re going to be forced to close departments, like we already see maternity departments are departments that we see closing,” Malone said. “Behavioral health departments are heavily Medicaid, Medicare populations, and so we’re going to see a lot of these closures.”
For nurses, many of whom have already long been dealing with burnout and exhaustion amid staffing shortages, the influx of sicker patients and possible hospital closures will further strain a profession that’s been experiencing an exodus of nurses, Malone said.
“We’re seeing it already. We’re seeing nurses retiring sooner than they had planned because the workload and the stress is just so astronomical,” Malone said. “I fear that we’ll see conditions similar to COVID, where we are working longer hours, doing more with less. We are taking care of sicker patients. I worry very much about health care workers and their own mental health because it’s really hard when you leave work at the end of the day and you don’t feel that you were able to provide that care that you know that these patients deserve.”
Already, nurses can feel as though they’re at a breaking point, even before people start losing their ACA or Medicaid coverage, Malone said.
“I know lots of nurses say they get to the car after a shift and sit and cry, and we’re not even here yet, right? We are not even seeing the effects of this yet, and nurses are already so desperately struggling,” Malone continued.
In the final days that the tax credits are in effect, Malone hopes Congress acts to extend them. Last week, the Republican-led Senate did not advance legislation that could have extended the tax credits. On Dec. 17, four House Republican lawmakers — including Pennsylvania Reps. Brian Fitzpatrick, Rob Bresnahan and New York Rep. Mike Lawler — joined their Democratic colleagues to sign a discharge petition from Democratic Rep. Hakeem Jeffries and force a vote on a three-year extension of the tax credits. The three Republicans from Pennsylvania represent districts they won with slim margins and which Democrats have targeted to flip in the 2026 midterm elections.
While there are enough signatures from lawmakers on the discharge petition to force a vote, a floor vote is not mandated until the first week of January — after the credits expire. Now, Democratic lawmakers and the GOP legislators who joined them on the petition are calling for House Speaker Mike Johnson to hold the vote before the end of the year.
“They have to put everything else aside, and they have to think about their constituents, and they have to think about the fact that this affects human lives,” Malone said.
