Immigrant Families in Philadelphia Face Health Insurance Crisis as ACA Subsidies Expire

As federal health insurance subsidies approach their expiration date, immigrant and mixed-status families in Philadelphia are emerging as some of the most vulnerable groups, facing a looming coverage cliff that could significantly reshape access to healthcare in 2026.

Since the COVID-19 pandemic, residents purchasing insurance through Pennie—Pennsylvania’s Affordable Care Act (ACA) marketplace—have benefited from enhanced premium tax credits that substantially reduced monthly costs. These subsidies are scheduled to expire on December 31, 2025. When new coverage takes effect in January 2026, thousands of Philadelphia households are expected to confront dramatically higher premiums.

Philadelphia Hit Harder Than Other Counties

The impact is projected to be particularly severe in Philadelphia, which has one of the highest concentrations of marketplace enrollees and wide income disparities. According to the latest Pennie data, average monthly premiums statewide are expected to rise by 102% once enhanced subsidies lapse. In Philadelphia County, the average increase is even higher—116%—amounting to roughly $137 more per member per month.

By comparison, neighboring suburban counties are projected to see smaller increases, including Montgomery County (63%), Bucks County (66%), and Delaware County (70%). These figures place Philadelphia as the non-rural county with the steepest projected premium hikes in Pennsylvania.

Growing Uncertainty and Early Coverage Losses

Although higher premiums have not yet taken effect, advocates warn that uncertainty alone is already fueling anxiety and disengagement. According to the Pennsylvania Health Access Network (PHAN), many residents are struggling to understand what their coverage and costs will look like in the coming year.

Marketplace turnover is already high. As of late December, more than 55,000 individuals were enrolled in Pennie plans across Philadelphia-area congressional districts. Pennie reports that for every new enrollee, two individuals are terminating coverage. Additionally, about 44% of new enrollees have not paid their January premium, raising concerns about further dropouts.

Philadelphia County has already seen coverage termination for approximately 10% of enrollees—over 6,000 people. Disenrollment is most common among adults aged 55 to 64, followed by those aged 26 to 34.

Income and Immigration Status Compound the Risk

By income level, coverage losses are most prevalent among individuals earning between $23,475 and $31,300, or families of four earning $48,225 to $64,300—roughly 150% to 200% of the Federal Poverty Level (FPL). These households are especially vulnerable to losing coverage due to income fluctuations or unresolved tax credit requirements.

Immigrant families face additional challenges layered onto the subsidy expiration. Beginning in 2026, low-income “lawfully present” immigrants who are not eligible for Medicaid will lose access to premium tax credits through Pennie. While immigrants above the low-income threshold remain eligible for now, further eligibility changes are expected in the coming years.

Philadelphia is home to the largest immigrant population in Pennsylvania, with nearly 15.7% of residents born outside the United States. For many immigrant households, the loss of enhanced premium tax credits could mean premium increases even higher than projected averages.

Another group facing total exclusion is DACA recipients, or Dreamers, who will no longer be eligible to enroll in Pennie plans. Mixed-status families—where eligibility varies among household members—are particularly affected, often requiring individualized guidance to navigate coverage options.

Outreach Efforts and the Risk of Disengagement

Advocates report a surge in calls during open enrollment, as residents who previously re-enrolled automatically now seek assistance. Organizations like PHAN offer multilingual helplines staffed by trained enrollment assistors who help families compare plans, verify provider networks, and understand costs.

Despite the uncertainty, advocates stress the importance of remaining engaged. Pennie plans are required to cover essential health benefits, including preventive services, mental health care, and maternity care. Residents are also encouraged to monitor communications from Pennie in case Congress acts to extend or modify subsidies.

Open enrollment continues through the end of the year for coverage beginning January 1, with later enrollment leading to a February 1 start date. Absent federal action, immigrant and mixed-status families in Philadelphia are being asked to make critical healthcare decisions amid uncertainty that could leave many without affordable coverage in 2026.

For those affected, advocates emphasize, the issue goes beyond rising costs—it threatens the loss of their only realistic pathway to health insurance, forcing families to choose between going uninsured or relying solely on overburdened safety-net clinics.