This week, Democrat lawmakers sounding alarms on threats to the Affordable Care Act at the federal level.

“If the folks in Washington are going to try to deny all the fundamental principles of the Affordable Care Act, that at least for the people of Pennsylvania, you will get them put into law here in Pennsylvania,” Sen. Vincent Hughes (D-Philadelphia) said at a press conference early in the week.

American health insurance is a hybrid unlike any other developed nation on the earth.

An American can purchase insurance straight from a private company, they can get insurance through their job, or they can purchase insurance off a public marketplace— where they may qualify for subsidies depending on their income level.

There are also a handful of non traditional insurance inspired methods that people participate in.

Democrat lawmakers say threats to undo the Affordable Care Act— which through expanded medicaid or subsidiesenrolled around 100 million Americans in insurance plans in 2024— puts Pennsylvanians at risk for being unhealthy and accruing medical debt.

“We’re the lookouts,” Sen. Patty Kim (D-Dauphin) said. “We are the lookouts for whatever drops from Washington, D.C..”

“House Democrats are determined to protect Pennsylvanian’s access to healthcare,” Rep. Mike Schlossberg (D) said, the majority leader in the House. "That means fundamentally protecting access to health care, regardless of any preexisting condition you may have. That means keeping adult children covered so that anybody up until the age of 26 can stay on their parents insurance.”

Critics of the Affordable Care Act say the system contributes to rising healthcare costs because of heavy regulation on insurance policies.

“What we currently have is not giving us affordable health care, so something needs to be done,” Elizabeth Stelle said, policy director at Commonwealth Foundation, a conservative think tank.

Kaiser Family Foundation reports that medical care costs have increased by 121% since the year 2000. All goods and services on average increased by 86%.

Stelle says that state lawmakers consider policy, it's possible to keep popular policies—like pre existing conditions or staying on parent’s insurance till your 26—without being stuck in an old system.

“We can keep what's working and fix what's broken,” Stelle said. "We can do that.”

The Affordable Care Act—or Obamacare as it was also called—passed in 2010. In its original form, the act made four changes to how health insurance operates in the United States.

First, the act mandated all Americans— with a few exemptions— must have insurance. If you did not have insurance as an individual, you paid a penalty. Congress voted to remove the penalty in 2017; the mandate still exists, but the fiscally punitive portion is not enforced.

If you are a business with 50 or more full time employees, you are required to offer health insurance or you will pay a fine.

Second, the act created a public market for insurance. A state could choose to run their own market, or there is a federal marketplace. Currently, there are 19 states who operate their own marketplace and 3 who split operation of the site between the state and the federal government.

Third, the act added new regulations on insurance companies. Many of the regulations apply to insurance policies both on and off the public marketplaces. Many of these regulations were politically popular in 2010, and as the Affordable Care Act comes under attack this year, they are the policies that lawmakers reference as worth keeping enshrined in law.

Fourth, the act expanded federal funds that went towards helping Americans with low income get insurance. The government expanded who could qualify for Medicaid. It also created subsidies for people who purchase insurance on the public marketplaces.

As of now, 23% of Pennsylvanians— around 3 million people— are enrolled in Medicaid. Around 500,000 purchased health insurance through the state’s public marketplace, PENNIE. Three out of four people who purchased on PENNIE used government subsidies.