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Pennsylvania’s uninsured rate reached a record low. Trump’s ‘Big, Beautiful Bill’ may reverse that.

A new report shows Pennsylvania's uninsured rate hit a record low in the years since Medicaid expansion. That could change under federal legislation backed by President Donald Trump.

President Donald Trump gestures while answering a reporter's question as Mehmet Oz (left), administrator of the Centers for Medicare & Medicaid Services, and Food and Drug Administration Commissioner Martin Markary listen during an event at the White House in May.
President Donald Trump gestures while answering a reporter's question as Mehmet Oz (left), administrator of the Centers for Medicare & Medicaid Services, and Food and Drug Administration Commissioner Martin Markary listen during an event at the White House in May.Read moreMark Schiefelbein / AP

The share of Pennsylvania residents without insurance dropped to a record low in 2023, a new report shows. But proposed federal spending cuts may roll back those gains.

The uninsured rate for working-age Pennsylvanians fell from 13.6% in 2013 to 7.1% in 2023, according to the Commonwealth Fund’s annual health system “scorecard.” Nationwide, the uninsured rate plummeted from 20.4% to 11% in that same period of time.

Pennsylvania ranked 13th in the nation for overall health performance, based on markers including affordability, outcomes, cost, and income disparity. In the Mid-Atlantic region, Pennsylvania came in third, lagging behind New York and the District of Columbia.

According to a news release shared by the Commonwealth Fund, a healthcare-focused nonprofit, the decline in uninsured rates may reflect the Affordable Care Act’s (ACA) Medicaid expansion, subsidized marketplace coverage, and the implementation of more consumer protections. Federal policy changes, including Medicaid funding cuts and work requirements, “may reverse those gains.”

Republicans’ “Big, Beautiful Bill” budget reconciliation package proposes to shrink Medicaid spending by at least $880 billion over the next 10 years. It would also place new limits on eligibility, including a work requirement for program participants. The bill, which is backed by President Donald Trump, has already passed the U.S. House and is now up for discussion in the Senate.

Roughly 23% of Pennsylvania residents are on Medicaid, according to the Pennsylvania Department of Human Services. In Philadelphia, the enrollment rate is 42%.

Sen. Dave McCormick (R., Pa.), a supporter of the “Big Beautiful Bill,” said he does not support taking “Medicaid away from people for whom the program was designed” in a debate with Democratic Sen. John Fetterman earlier this month.

“What I’m arguing for is that we need to cut out the use of those programs by people for whom they weren’t designed,” McCormick said.

Although Fetterman said he opposed the bill, he agreed that there is room to cut fraud “efficiently.”

“I don’t think I’d ever be in a position to support cutting Medicaid,” he said.

Fetterman also addressed Medicaid cuts in a post on X last week, writing “it’s not a talking point that we need to fight for Medicaid — it’s truly a matter of saving lives.”