Nearly 40,000 Pennsylvanians dropped their Obamacare coverage this year. The shocker is that the largest drop in coverage came from middle-income families earning over $132,000.

Athan Koutsiouroumbas

The decline is not due to job loss or ineligibility. Rather, it appears that middle-income families simply can no longer afford the Affordable Care Act. That statistic challenges the popular image of someone who depends on government assistance. Or more important, who is forced onto it. They are teachers married to engineers, small business owners, sales representatives, nurses and police officers. In addition, they are families juggling mortgages, childcare, youth sports, groceries and college savings while trying to do everything we traditionally associate with the American middle class. But when the enhanced Affordable Care Act subsidies expired in January, so did that assistance. Many suddenly found themselves paying hundreds of dollars more each month for the same coverage. Instead of paying the higher prices, middle income families are choosing to forgo government-backed health insurance. That raises an important question. Wasn't the Affordable Care Act supposed to make healthcare more affordable? The answer is yes, but perhaps not in the way many Americans assumed. Obamacare largely made health insurance more affordable by subsidizing premiums, while also attempting to slow the growth of healthcare spending. What most recognize is that Obamacare failed to substantially lower the underlying cost of medical care itself. For millions of Americans, affordability came because taxpayers paid a larger share of the bill through subsidies. As those enhanced subsidies disappear, families are discovering the difference between reducing what they pay and reducing what healthcare costs. A family earning $140,000 or $150,000 can easily face annual health insurance premiums approaching or exceeding $20,000 depending on age, location, and plan selection. Under the enhanced subsidies, many received meaningful federal assistance that capped what they were expected to contribute. Today, these middle-income families receive nothing. Which brings us to politics. Who will these voters blame for their inability to afford health insurance: the Democrats who created it, or the Republicans who failed to repeal it? Pennsylvania remains one of the nation's premier battleground states, and many of the voters who will determine control of Congress live in communities where household incomes routinely exceed $132,000. Four such districts are located here in the commonwealth, and they are among the most competitive congressional races in the country. That creates a political challenge for both parties. Republicans are likely to argue that the answer is not restoring larger subsidies but tackling the underlying drivers of healthcare costs that Obamacare never solved. They will contend that simply asking taxpayers to shoulder an ever-larger share of rising premiums is financially unsustainable. Instead, Republicans are likely to advocate for greater competition among insurers and providers, expanded consumer choice, price transparency, regulatory reform and policies they believe would reduce the actual cost of healthcare rather than simply shifting more of the bill to taxpayers. Democratic candidates may argue that Congress should restore enhanced subsidies because they prevented millions of families from facing these premium increases in the first place. They may insist that healthcare remains unaffordable for many middle-income households without federal assistance and that allowing the subsidies to expire effectively imposed a tax increase on working families. Democratic candidates are also likely to advocate that preserving affordable coverage improves public health, financial security, and access to preventive care while broader efforts to reduce healthcare costs continue. The middle-income voters who just opted out of Obamacare may not embrace either argument in full. Health insurance is no longer just a healthcare issue. It is an affordability issue. Like housing, groceries, childcare and energy, it now competes for a larger share of the family budget than many households believe they can sustain. That makes these Pennsylvanians a growing bloc of middle-income voters who feel they are doing everything society asked of them yet still find essential expenses slipping out of reach. In 2026, the candidate that simply promises more or less Obamacare may not prevail. The candidate who convinces these voters he or she can make everyday life more affordable just might. (Athan Koutsiouroumbas is a managing director at Long Nyquist and Associates and a former congressional chief of staff.)

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