Health Care is Too Expensive. Governor Shapiro Can Do Something About It.

Declining enrollment in Pennie, Pennsylvania’s “answer” to the Affordable Care Act (ACA), is proof that health insurance is still too expensive. The enhanced COVID-19 subsidies temporarily hid the cost for many enrollees, but they did not change the fact that sweeping government interventions did not deliver affordability.

Last fall, the Pennie Health Insurance Exchange Authority projected enrollment would fall by 150,000 this year as the extra subsidies expired. At the end of the open enrollment period, enrollment declines stand at 85,000. Overall enrollment, including new enrollees, is down by 2 percent, or 10,661. So far, the declines are far less than predicted, but more individuals will cancel coverage as premiums come due in the early months of 2026.

Now is the time to give Pennsylvanians more control over their health care. There are good ideas circulating in Washington, D.C., to empower people, such as giving Medicaid recipients a health savings account that allows them to save tax-free for future needs.

Short-Term Health Plans

But Pennsylvania can do something, too. Gov. Josh Shapiro can instruct the Insurance Department to allow renewals for short-term health plans. These plans are affordable because they do not cover all 12 mandated benefits under the ACA. For healthy individuals without employer coverage, these plans offer affordable protection from medical emergencies.

Currently, Michael Humphreys, Shapiro’s acting Insurance Commissioner, won’t allow renewals despite the Trump administration giving them the green light. In a recent letter, the commissioner defended this decision, stating that these plans have “significant drawbacks” while also noting that Pennie’s premium increases are even worse than initially projected.

Health Association Plans

Lawmakers should pass health association plans, which allow small businesses to pool together to provide their employees with more affordable coverage. Since the advent of the ACA’s avalanche of mandates, small businesses offering insurance plummeted from 47 percent in 2000 to 30 percent in 2023. These plans can help small businesses compete for workers,

But, again, Shapiro stands in the way. As attorney general, he litigated against federal rules that would allow different kinds of businesses to form association plans, bragging the lawsuit would “protect Pennsylvanians’ care.” Because of Shapiro’s efforts, the rule allowing more types of associations remains unresolved and tied up in appeals.

Price Transparency

Finally, transparency is key. When patients don’t know the price, they can’t make an informed health care decision. Getting serious about enforcing hospital price transparency can pressure health providers to make prices easily accessible, helping us all make better financial and health choices.

Shapiro’s commitment to price transparency has been superficial at best. During his 2025–26 budget address, Shapiro demanded “transparency in pricing in health care.” However, since then, he hasn’t worked to advance a legislative solution, nor did he mention the topic in this year’s budget address.

There is a path to affordable health care, and it doesn’t run through subsidies that hide the cost. Instead, it runs through empowering patients to control their health care dollars—so long as elected officials like Shapiro get out of the way.