Mark Pinsley, the Democratic nominee for Pennsylvania Senate District 16, believes health care is a human right and nobody should go without it because of cost. His long-term goal is universal health care: coverage for every Pennsylvanian. He would fight to protect Medicaid, bring insurance premiums down now, and lower costs before you get the bill: real price transparency from health care providers, a cap on out-of-pocket costs for essential drugs like insulin, and cutting out the middlemen who drive up drug prices.
As Lehigh County Controller, he has already taken on some of the biggest health care companies over what the county was paying them. In Harrisburg, he would take them on again for every Pennsylvania family.
1. Protect Medicaid
About 3 million Pennsylvanians, nearly one in four, get their health coverage through Medicaid. (Spotlight PA)
The federal budget law signed in July 2025 cuts federal Medicaid funding by roughly $1 trillion over ten years. The state estimates that about 310,000 Pennsylvanians will lose their coverage, and Pennsylvania’s Department of Human Services has said the state can’t make up the lost federal money on its own. (Spotlight PA)
The biggest changes start on December 31, 2026: many adults ages 19 to 64 will have to report 80 hours of work a month, and prove they still qualify every six months instead of once a year. (North Penn Legal Services) State officials warn that the added paperwork will push off people who still qualify, including children, seniors and people with disabilities caught in the backlog. (WPSU, August 2026)
He warned Lehigh County before the cuts passed. In March 2025, Pinsley held a public town hall as Controller, Your Wallet vs. Medicaid Cuts: The Fight You Didn’t See Coming. He showed that about 23,800 Lehigh County adults, roughly one in ten between 18 and 65, were covered through Medicaid expansion, the group his office expected cuts to hit hardest. And he made the case that cuts don’t save money: people who lose coverage still get sick, wait until it’s an emergency, and end up in the ER, where taxpayers and insured patients pick up the bill.
In May 2025, months before the law was signed, his office followed up with a special report, The DOGE Effect: Lehigh County’s Medicaid Dilemma. It found:
- Medicaid sends about $168 million a year into Lehigh County’s most critical services.
- At Cedarbrook, the county’s 670-bed nursing home, care costs about $12,700 a month per resident. Medicaid pays about $8,300. The county already fills a $36 million yearly gap with other grants.
- Even a 10% Medicaid cut would cost Cedarbrook about $7 million and the county’s disability and mental health programs about $10 million. Covering that, plus the county’s existing $4 million budget gap, would take a property tax increase of about 18%.
- Families could end up paying. Pennsylvania’s filial responsibility law lets nursing homes sue adult children for a parent’s unpaid bills, and in 2012 a court ordered a son to pay $93,000 for his mother’s care.
He urged the county to plan for cuts before they came, and recommended that the General Assembly end or reform the filial responsibility law so families aren’t left holding the bill. (Town hall presentation, March 11, 2025 · Special Report, The DOGE Effect, May 14, 2025)
Pinsley calls the federal cuts a disaster for working Pennsylvanians, and would fight to protect Medicaid coverage in Harrisburg. As a state senator, he could also take up the filial responsibility reform his own report called for.
2. Bring insurance premiums down now
About 417,000 Pennsylvanians buy health insurance through Pennie, the state’s insurance marketplace. When enhanced federal tax credits expired at the end of 2025, Pennsylvania lost about $600 million a year in help with premiums, and Pennie customers’ costs roughly doubled on average.
In the nine months to September 2026, 202,000 people dropped their Pennie coverage, and Pennie says many of those who left are now uninsured.
Pennsylvania already has a fix on the books. It just hasn’t paid for it. Act 54 of 2024 created the State Health Insurance Exchange Affordability Program to help people pay their premiums, and the program has never been funded. Pennie estimates that $50 million — about one-twelfth of the lost federal help — would lower the average premium 9% to 12% for more than 280,000 people, and let nearly a quarter of those who dropped coverage come back. (Pennie · Reps. Mazzocco, Venkat and Samuelson, September 10, 2026)
Pinsley would fund it. It’s a step the state can take right now, while doing the harder work of bringing down what care actually costs. (The Morning Call, October 5, 2026)
3. Make prices public and cut out the middlemen
Hospitals, insurers, drug companies and pharmacy benefit managers (PBMs) — the middlemen between drug makers, pharmacies and your insurance — should have to show their real prices, so families know what something costs before the bill comes.
In a 2020 paper, Pinsley showed how pharmacy benefit managers use secrecy to protect their power over drug prices. He explained two ways PBMs keep prices hidden:
- Rebates: drug makers pay PBMs to favor their drugs, and PBMs can keep as much of that money as they want.
- Spread pricing: a PBM pays the pharmacy $10, bills the employer $12, and keeps the $2.
Neither is illegal, and the employer paying the bill sees neither. The paper also found about 16% of independent pharmacies closed over fifteen years, leaving some rural and low-income areas without one. (PBM paper, November 2020)
Open the books on drug middlemen. Pinsley would require public reporting of PBM rebates, prices and what they pay pharmacies. For state contracts, he would look at flat fees that end spread pricing, and require competitive bidding and independent audits. (The Morning Call, October 5, 2026)
Real penalties for hospitals that hide their prices. Pinsley would push for Pennsylvania penalties large enough to force hospitals to post their real prices. Federal law already requires it, but the maximum penalty for a large hospital is about $2 million a year, small enough for a big health system to treat as a cost of doing business. His 2022 audit showed what hidden prices cost: the county’s health plan was paying hospitals more than their own posted cash prices, and the audit identified about $4 million a year in potential savings. (Report 22-16 · Lehigh Valley Public Media, October 2022)
Open, conflict-free bidding for public health plans. Pinsley would require public health plans to be competitively bid, keep insurance brokers who can be paid by insurers from helping choose the winner, and have bids presented and published in the open. His office made the same recommendations to Lehigh County in 2025. (July 2025 memo)
He has already done this in Lehigh County
As Controller, Pinsley pushed for a competitive rebid of the county’s prescription plan, and the county saved $3 million in its first year, according to the County Executive. (WFMZ, October 2022) His audits have also recovered money billed in error, including $46,884.59 from the county jail’s health care vendor. More: What has Mark Pinsley done to lower health care costs in Lehigh County?
4. Cap costs for essential drugs
People with Type 1 diabetes can’t skip insulin. Pricing it as if they could isn’t a market — it’s leverage. Pinsley would cap out-of-pocket costs for essential medications like insulin.
5. Use the state’s buying power
Pennsylvania buys huge amounts of prescription drugs through Medicaid, state employee plans and prisons. Pinsley wants the state to use that volume to negotiate lower prices.
His office has proposed letting small businesses and nonprofits join a county-led health care buying group, so they could get the same rates the county gets (July 2025 memo).
6. Universal health care
Pinsley supports Senate Bill 1465, the PA Universal Healthcare Act, introduced in September 2026 by Sen. Nikil Saval. It would create a single-payer system covering every Pennsylvania resident, plus non-residents who work at least 20 hours a week in the state. The bill is now in the Senate Health & Human Services Committee. (Sen. Saval’s co-sponsorship memo · Bucks County Beacon, September 2026)
The steps above would lower costs now. Universal coverage is where they lead: health care no one goes without because of cost.
Common questions
“Isn’t health care a service people should pay for?” When people can’t afford a checkup or medicine, they end up in the emergency room, where care costs more — and someone still pays. The cost doesn’t go away. It grows.
“Shouldn’t the free market set prices?” Health care isn’t a normal market. Someone having a heart attack can’t shop around. Transparency makes the market work better.
“How would universal health care be paid for?” Senate Bill 1465 would fund it through a payroll tax. Sen. Saval says it would cost most families less than they now pay in health insurance premiums. (Sen. Saval’s co-sponsorship memo)
“Isn’t negotiating prices just price-fixing?” Big employers, insurers and PBMs negotiate drug prices every day. The question is whether the state will do the same for taxpayers and patients.
District 16 covers parts of Lehigh and Bucks counties. The general election is November 3, 2026.
