The 1991 Comparison: Context & Policy Mechanics
In her AxiosLive discussion with Isaac Avilucea, Pennsylvania State Rep. Borowski cautioned that rising medical inflation, employer cost-shifting, and shifting Medicaid/CHIP rolls risk reverting household financial exposure back to the acute coverage vulnerability of 1991. Prior to major 1990s state reforms and the subsequent ACA coverage expansions, out-of-pocket volatility and insurance denial rates placed comparable strain on median income earners.
Sources & Verification: AxiosLive interview with PA Rep. Borowski (Sept 2026); Pennsylvania Department of Human Services Historical Coverage Series; Bureau of Labor Statistics Consumer Price Index Medical Care Component (1991–2026).