Pennsylvania’s Healthcare Lottery
Southwestern Pennsylvania is getting old. In Washington County, the small place south of Pittsburgh where I was born back in 1982, 23.2% of residents are now 65 or older, against 20.4% across Pennsylvania and 18% nationally. Allegheny isn’t far behind. Both populations have aged steadily for two decades as factories closed and younger people left for places with better job markets.
The older you get, the more time you spend dealing with the American healthcare system, which is part of what makes the new RealClear Opinion Research and Emerson College survey of 2,012 Pennsylvania residents on healthcare costs, access, and reform (margin of error 2.2 percentage points) worth a slow read in counties this grizzled. The poll opens with a near-tie: 48% of Pennsylvanians describe affording healthcare as easy, while 46% describe it as difficult.
62% of Pennsylvanians with postgraduate degrees describe affording healthcare as easy. The figure drops to 53% for college graduates, 45% for those with an associate degree, and 40% for those whose schooling stops at high school. White respondents (51%) are likelier than Black respondents (47%) or Hispanic respondents (37%) to call costs manageable. One in three Pennsylvanians, or 33%, reports that someone in the household struggled to pay a medical bill in the last 12 months.
27% of Pennsylvanians who had to make tradeoffs to pay for healthcare borrowed money. 22% stretched a current prescription past its intended duration. 13% cut back on utilities, 12% drove less, and 12% skipped a meal. By insurance type, only 11% of poll respondents pay out of pocket primarily; 40% use private insurance, 30% Medicare, and 14% Medicaid.
My mother’s sister is in her late seventies and still lives in Washington County. Her husband spent more than three decades underground and retired with full UMWA Health and Retirement Funds coverage, the considerable benefit that came out of the 1946 Krug-Lewis agreement and currently pays roughly $514 million in annual medical claims to around 100,000 retired miners, widows (of which she is now one), and dependents. My aunt’s coverage is Cadillac care, and for all her real-life struggles, she has never debated whether to fill a prescription.
A neighbor of my mother’s, the same age, retired from a non-union job into Medicare Advantage with a thin supplement plan. She weighs every co-pay. If a pollster called both of them on the same Tuesday afternoon, one would likely describe Pennsylvania healthcare as easy to afford and the other would describe it as difficult, and both would be answering candidly with regard to their own situations.
The hospital where I was born, back when it was still a 127-year-old independent community institution, became UPMC Washington in June 2024, after UPMC absorbed the Washington Health System in a $300 million transaction that local officials of both parties argued was the only thing keeping nearly 300,000 people in Washington and Greene counties from losing close-to-home care. The system had been hemorrhaging $34 million a year. Owing to consolidations like this, UPMC now operates 40 hospitals and 800 other locations across the region, while Allegheny Health Network added Heritage Valley in October 2025 and is putting a billion dollars into a new cardiovascular tower at Allegheny General. The two networks have effectively carved up Western Pennsylvania – until a much-needed recent legislative reform, UPMC even limited the job mobility of their physicians – and which insurance titan covers you determines which doctors can see you and what being seen will cost.
64% of Pennsylvanians are concerned about hospital closures, with concern peaking in the North-central region (78%) and the Southeast (71%) and bottoming in the South-central region (51%). The Southwest registers 60%. Heritage Valley Kennedy in Kennedy Township closed in June 2025, Crozer-Chester Medical Center closed a month earlier, and the Pennsylvania Health Access Network has warned that as many as 25 additional Pennsylvania hospitals could close over the next several years once the Medicaid cuts from the One Big Beautiful Bill Act start to impact these facilities in 2028.
For now, when asked whether their own community has enough hospitals, 62% of Pennsylvanians say yes statewide. The Southwest, post-consolidation, registers 70% yes; the North-central region splits 48% yes to 45% no. Pennsylvania currently carries roughly $1.8 billion in outstanding medical debt affecting 13% of the state, and six in ten working-age Pennsylvanians with insurance have incurred medical debt within the past five years. As of this month, roughly 120,000 Pennsylvanians have dropped ACA coverage through Pennie (the state’s official health marketplace) since November, and post-open-enrollment cancellations are running nearly 50% above last year's pace, after federal subsidies expired and premiums shot up by triple digits in some counties.
Despite these significant debt burdens, questions of financial support for lower-income individuals and the health professionals who care for all of us vary considerably. 51% of Pennsylvanians support work requirements for Medicaid and SNAP recipients, against 30% who oppose. The workforce questions, however, show significant support: 73% support hospital repayment of nursing graduates' student loans (in exchange for a three-year service commitment), with similar majorities backing apprenticeship expansion (79%) and a modest pay raise for direct care workers (71%).
My aunt and my mom’s neighbor will both experience their final days at an AHN or UPMC facility in not too very long. Medicare and the UMWA Funds will cover everything for my aunt, the way they have for the past twenty-some years. A collective bargaining agreement signed in 1946 is still doing the work of keeping her covered in 2026, eighty years after the negotiation ended. My mom’s neighbor has nothing comparable, and nothing Harrisburg passes between now and her death is going to change that – it’s up to the luck of the draw, in this case the card you’re drawing from your wallet.
