Since the Trump administration’s One Big Beautiful Bill Act took effect in 2025, Pennsylvania physicians say they have already seen the impact on hospitals and emergency departments.
Enhanced Affordable Care Act premium tax credits expired last year and Medicaid changes begin rolling out January 2027, leaving some patients to delay or avoid seeking medical care altogether because they can no longer afford insurance.
Physicians warn that this avoidance of preventative and routine care could actually create more medical emergencies in the long run.. When outbreaks or illnesses take hold, hospitals across the state are at risk of overcrowding with an influx of emergency room patients.
Emergency physician Dr. Max Cooper works at a community hospital in Bucks County and co-founded the Committee to Protect Healthcare, an organization of 50,000 physicians working toward universal healthcare, affordable medication and reproductive freedom. He said he is seeing longer wait times for care in the ER.
“I’ve seen significantly expanded wait times in the emergency department. It’s something that’s become very common,” Dr. Cooper said. “I regularly see people waiting 10, 11, 12 hours to be seen in the waiting room.”
The OBBBA made it more difficult for low-income individuals and families to obtain health insurance by removing subsidies that had previously lowered premiums. As more patients lose coverage, uncompensated care places financial strain on hospitals, leaving them to ration resources—including staff—to make up for monetary losses.
“When the cuts happen, that money for how well we operate as a team and all of the extra support services start to get strained,” Bethlehem family physician Dr. Courtney Humphrey said.
ACA premium tax credits expired at the end of 2025 and OBBBA did not address a solution to the expiration, letting them dissipate. Pennsylvania Republican congressmen, Dan Meuser, Scott Perry, Lloyd Smucker, John Joyce, Guy Reschenthaler, Glenn Thompson and Mike Kelly all voted against the continuation of the subsidies. All of the House Democrats voted in favor, only three Republican representatives joined them for the affirmative, this included Brian Fitzpatrick, Robert Bresnahan and Ryan Mackenzie.
“When those (premium tax credits) did not get extended, a lot of people were unable to afford what the new premiums were, and so they opted to not have healthcare because they couldn’t make the finances work,” said Dr. Humphrey. “We’ve seen them more in acute crises than for the prevention or the maintenance of their illnesses.”
Medicaid eligibility and budgets also changed as a result of OBBBA. According to the American Medical Association, states previously used provider taxes to fund Medicaid programs; now their ability to use those sources is restricted. New work requirements, slated to take effect in early 2027, state that adults seeking Medicaid coverage must work at minimum 80 hours a month, earning roughly $580 at minimum wage.
Before these new work requirements, there was no one average income for families or individuals on Medicaid. For a program like this that is meant for low income families, it has a cap on how much you can earn to stay eligible for the benefits, rather than a general average amount people are earning.
This income range spans from $0-$21,600 a year, and is concluded from the Federal Poverty Line. 45% of Medicaid recipients are full-time working adults, who may reach the new requirements already, depending on their income. However, the 27% of people who can only work part-time and the 28% who are unemployed due to disabilities or other restrictions could be affected by these changes.
In Pennsylvania, approximately 3 million people—23% of the state’s population— rely on Medicaid coverage for their healthcare. Of those 3 million, 39% are minors. Medicaid also covers 59% of nursing home residents in the state.
“The first noticeable change we had is for those who were relying on the premium tax credits,” Dr. Humphrey said.
Drs. Humphrey and Cooper said many patients find themselves weighing the cost of basic necessities vs. health coverage.
“We’re just unfortunately seeing patients have to choose between rent and groceries and gas and health insurance,” Dr. Humphrey said.
Critical preventative care has also taken a hit.
“The things that could previously have been taken care of by a primary care physician… they now do not have a primary care physician because they don’t have health insurance,” Dr. Cooper said. “So, they avoid, avoid, avoid. All of a sudden, their healthcare is now at a crisis level.”
For providers like Dr. Humphrey, these choices aren’t theoretical. One of her patients lost his Marketplace coverage after premium tax credits expired and could no longer afford the medication that kept his asthma at bay.
“When he lost his coverage because of losing the premium tax credit extension, he couldn’t afford his monthly premium anymore, and so he went without his medications,” Dr. Humphrey said. “He’s ended up in the ER more often than he’s ever been with asthma flares. We’re seeing preventative complications. Things we know that if we could treat the issue, we don’t have ER visits.”
Upland-based Crozer-Chester Medical Center, formerly owned by Prospect Medical Holdings, permanently closed in May 2025 due to bankruptcy. Dr. Cooper worked at this facility until its closing.
Dr. Cooper worries that Crozer-Chester will not be the only hospital closure in Pennsylvania. OBBBA changes have left medical centers vulnerable to closure, especially in areas that serve large Medicaid populations.
“I’m really worried it’s going to cause some hospitals in Bucks (County) to shut down,” Dr. Cooper said. “Even if you have health insurance, you can’t go to the ER and get timely care because there’s so few hospitals left that there’s just this massive healthcare bottleneck.”
The Medicaid recertifications and work requirements slated to begin in 2027 are not the only concerns. Medicaid financing restrictions are expected to take effect in 2028, which will also increase pressure on hospitals.
Dr. Cooper and Humphrey say a significant number of coverage losses happen because of administrative barriers rather than ineligibility. They worry that people who qualify for health insurance could lose access from the documentation burden alone.
Cooper said many people view health insurance as something that only affects them individually, but he argues that the effects go beyond one uninsured patient.
“This is more than an individual person’s problem,” Dr. Cooper said. “This is a systemic issue about how we deliver care… I would hope that people think about this as a systems issue and not an individual one.”
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