稳定2026年宾夕法尼亚州健康保险市场：立法简报
宾夕法尼亚州因联邦补贴到期和保费上涨，导致约8.5万居民失去医疗保险，中等收入家庭平均保费增幅高达102%。
为了应对这一危机，研究表明可以通过三个主要政策手段来扭转趋势：一是针对400%-600%家庭贫困线(FPL)人群提供州政府保费补贴；二是扩大再保险规模（PA-RE），以降低高额医疗索赔带来的成本；三是恢复导航员及宣传服务，帮助居民选择更具性价比的银牌计划或医保。
目前，宾夕法尼亚州的再保险计划处于暂停状态，导航员资金不足，亟需采取行动。
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# **LEGISLATIVE BRIEF: Stabilizing the 2026 Pennsylvania Health Insurance Market****Date:** May 4, 2026 **Subject:** Evidence-Based Policy Response to the 102% Premium "Subsidy Cliff"### **The Crisis at a Glance*** **85,000** Pennsylvanians dropped coverage following the expiration of enhanced federal credits. * **102%** average premium increase for middle-income families (\>400% FPL). * **Critical Risk:** Younger, healthier enrollees are exiting the market, leaving a "sicker" pool that will drive 2027 rates even higher.### **Research-Validated Policy Levers**Academic consensus (Anderson et al., 2025; Roy, 2020\) identifies three primary mechanisms to reverse these trends. Pennsylvania’s 2026 implementation status is as follows:#### **1\. State Premium Assistance Backstop*** **The Logic:** Targeted state subsidies to replace expired federal credits for the 400%–600% FPL range. * **Evidence:** States with "wraparound" subsidies see 12-18% higher retention of middle-income enrollees. * **PA Status:** **PENDING.** Legislation drafted (Scott/Powell) but currently lacks a dedicated funding stream.#### **2\. Reinsurance Expansion (PA-RE)*** **The Logic:** Lowering gross premiums by capping insurer liability for "high-cost" claims (e.g., GLP-1 specialty drug users). * **Evidence:** Reinsurance programs empirically lower premiums by 6–10% on average (Abraham et al., 2019). * **PA Status:** **INACTIVE.** Current stop-loss is insufficient for the 2026 volatility spike.#### **3\. Navigator & Outreach Restoration*** **The Logic:** Funding "boots-on-the-ground" assistance to help enrollees transition to lower-cost Silver plans or Medicaid. * **Evidence:** Retention is 2x higher in areas with institutional navigator presence (Hill & Jacobs, 2024). * **PA Status:** **CRITICAL.** Navigator funding was reduced post-OE; county programs are at 110% capacity.
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