Why 2026 Could Be a Tipping Point for Health Care in Pennsylvania Congress allowed key health care subsidies to expire—on top of Medicaid cuts—and the impact won’t be equal. Rural counties, self-employed workers, farmers, small business owners, and older adults will be hit first and hardest. This is what experts are calling the “rural penalty.” And when rural hospitals destabilize, everyone pays more—even people who think their insurance is safe. Families are already stretched by rising housing