Governor Josh Shapiro and the General Assembly reached agreement on a $50.8 billion state budget nearly two weeks after the June 30 deadline. The final spending plan represents an increase of approximately $1.8 billion, or 3.7%, over the prior fiscal year. 

For the Pennsylvania Orthopaedic Society, the budget process was relatively quiet. Legislation enacted along with the state budget did not include significant changes affecting orthopedic practices, physician ownership of facilities, radiologic technologist licensing, or scope of practice. One budgetary element of interest to PAOrtho and the broader physician community, however, is the transfer of money from the Pennsylvania Professional Liability Joint Underwriting Association to the state’s General Fund.  

Joint Underwriting Association Transfer 

The Fiscal Code legislation, a necessary bill to authorize budgetary expenditures, transfers $14.3 million from the Pennsylvania Professional Liability Joint Underwriting Association, commonly known as the JUA, to the General Fund for the 2026-27 fiscal year. 

The JUA serves as Pennsylvania’s insurer of last resort for physicians and other health care providers who are unable to obtain medical professional liability insurance through the traditional market. The budget does not directly change JUA eligibility, coverage, or premiums, but the transfer continues the Commonwealth’s recent practice of using JUA reserves to support the General Fund. 

The Commonwealth transferred $200 million from the JUA to the General Fund in August 2025 following nearly eight years of litigation. The FY 2025-26 budget then required another $100 million transfer, which was completed in December 2025. The new budget authorizes an additional $14.3 million transfer. 

Once the latest transfer is completed, the Commonwealth will have withdrawn $314.3 million from the JUA since August 2025. PAOrtho should continue monitoring these transfers and their potential effect on the association’s reserves and ability to fulfill its insurer-of-last-resort function. 

View the full PAOrtho Legislative Tracker (PAOrtho Members Only)