‘We’re very concerned’: Q&A with Pennie Executive Director Devon Trolley

Just days before this year’s open enrollment for Pennie plans – and four weeks into a federal government shutdown centering largely around whether to extend insurance subsidies – Devon Trolley, the head of Pennie, Pennsylvania’s state health insurance marketplace, finds herself, her agency and its half-million enrollees at an inflection point.

If Congress fails to extend them, the enhanced premium tax credits that subsidize plans for 90% of Pennie enrollees will expire at the end of 2025 – more than doubling enrollees’ insurance costs, on average, through a combination of subsidy losses and premium increases. Trolley told City & State how Pennie and its consumers are preparing, shared her best- and worst-case scenarios, and explained why, in this time of uncertainty, knowledge really is power for health consumers.

The interview has been edited for length and clarity.

As things stand today, what are the best- and worst-case scenarios for Pennie consumers?

We haven’t started open enrollment yet, so the best-case scenario would be an immediate extension – a vote today to extend enhanced tax credits into 2026 and beyond. Sooner is better; it just means less confusion. But that doesn't look likely, and once we get into open enrollment, starting Nov. 1, it does get a little more complicated.

The worst-case scenario is that enhanced tax credits are not extended, and that people’s costs go up, maybe double – in some counties (like Juniata), we’re seeing average cost increases of over 400%. The higher increases tend to be more in the central parts of the state, the rural parts. 

We could also see up to 150,000 people unenroll and go uninsured. They’d go from having that peace of mind that they can go to the doctor when they need to, that they can get prescriptions they need, that they’re protected financially in the case of an emergency, to living on the edge – being at risk of any accident putting people in medical debt, afraid of not catching illnesses early or not being able to treat them when they’re found. So we’re very concerned.

What would that scenario look like across the commonwealth?

We currently have a record number of enrollees, almost 500,000. Apart from the 150,000 that may drop because costs are set to double, it’s important to note that the other 350,000 will see very large increases in their costs.

A lot of enrollees are concerned about how paying for those increases will impact the rest of their lives – like less investment in their small businesses, and difficulty making room for additional costs in the rest of their budget.

We’d start to see those negative impacts on Pennsylvanians, on both their health and their finances – but also on their ability to work, to contribute to their communities, to have local economies thrive. What we hear from people, especially many small business owners and farmers who have coverage through Pennie, is that there are many direct trade-offs between their ability to do their jobs, their ability to keep their small businesses, and the cost of health insurance.

How has Pennie’s team been preparing for these scenarios?

We’ve been trying to prioritize communication – both directly to people enrolled in Pennie and to policymakers at the state and federal levels about the impacts of the enhanced tax credits expiring.

This past summer, we started sending out informational packets for Pennie enrollees, saying, "These enhanced tax credits expire at the end of the year without congressional action. This will mean lower premium tax credits and higher costs come open enrollment." We thought it was important to do so because we heard directly from people that they wanted the time to plan ahead.

We have some enrollees who literally rely on this coverage for life-saving treatments or prescription drugs. What we’ve heard from them is that they’ve been saving money, so if these costs go up, they can continue to stay enrolled and receive that life-saving care. We’ve heard from others who say it’s not even an option to accommodate some of the increases we’re talking about. And we’ve heard from some enrollees that they’re thinking about which medical issues to address this year, in case they have to drop coverage.

So we thought it was really important to tell people early that this is a possibility. And our emphasis as we start open enrollment is to communicate again and again, making sure people read their information for next year, understand what the costs are, look at their other options and make informed decisions.

How are you advising consumers to strategize around open enrollment? Should they postpone enrolling to see how things play out?

I think it’s fine to come at any time during open enrollment to look at options. In fact, it’s probably better to make sure the plan they’ve been automatically renewed into next year works for their budgets and their families. If not, they need to look at other options – what’s available in their area – because some people will experience these increases at double or even higher levels, while others will see less of an increase.

A key message is that it’s important to update household and income information. This is not related to the enhanced tax credits, but there are federal changes that increase penalties for people who do not estimate their income correctly. We want people to make sure that what they’re estimating for next year still really is aligned with what they’re expecting.

Is there more movement than usual in the market this year among insurance providers or plans, due to all this uncertainty?

You know, we haven’t really seen much difference in plan options or availability. We still have a lot of plans out there for people to choose from. There are always changes every year in what health insurance companies offer – but we haven’t seen major shifts.

I think it’s just that costs are going up overall. Rate increases are much larger than in prior years.

Why is that?

Part of it – not all of it, but part of that larger increase is tied to the enhanced tax credits. Insurance companies look at what medical costs they’re expecting next year, and then what premiums they need to charge in order to pay for those medical costs.

When you have enhanced tax credits going away, and what people pay has to go up, the first people who drop coverage tend to be the healthier people. Those are the ones who are a little more willing to take the risk that they’ll stay healthy, that they won’t need medical care next year, that they won’t get in some type of accident or have some type of injury.

But the people who have medical conditions really don’t have any other option but to find a way to pay for health insurance. So what happens then is that you don’t have a balanced risk pool. If you only have sick people buying health insurance, that health insurance is going to go up for everybody, because each person needs to pay more into their insurance in order to cover the medical costs if you don’t have healthy people.

So the insurance companies did increase their rates by a certain amount, assuming that healthy people would drop. And so that’s just one example of how the enhanced tax credits have broader implications. It’s not just the cost going up for people this year; when you have a weaker family market, those costs will continue to rise every year.