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| Pocono Record
Barrett: I made no promises to Trump on ACA ruling
Supreme Court nominee Amy Coney Barrett says she has not promised to anyone, including President Donald Trump, that she would vote to repeal the Affordable Care Act. She called any such pledge a “gross violation of judicial independence.” (Oct. 13)
For two years, Stacie Ritter worried about losing her 4-year-old twins to cancer. The third year, she worried about losing the family home.
Madeline and Jan Ritter, now 22, survived. The family survived medical bankruptcy.
But now, Stacie Ritter finds herself worrying about the health of her twins again.
The Patient Protection and Affordable Care Act — better known as Obamacare — has provided the Ritter twins with guaranteed access to affordable health care and protections that did not exist in 2002, when they were diagnosed with leukemia.
The twins’ current health coverage, and the ability to maintain it, relies on keeping those guarantees and protections in place, said Stacie Ritter, who lives in Manheim, Lancaster County.
Jan, who is studying early childhood education, is among an estimated 89,000 Pennsylvanians under age 26 who is covered under their parents’ employer-provided health insurance.
Madeline, a middle school teacher with AmeriCorps in Washington, D.C., has coverage through Medicaid, the government insurance for low-income adults and people with disabilities.
“My fear for them in the future now is, if these protections are overturned, are they going to be priced out of the market?” Ritter said. “The law has been the law for 10 years so they don’t know what it was like before. They don’t realize what they’re going to lose.”
The U.S. Supreme Court is expected to begin hearing arguments next month in the latest legal attempt to overturn the Affordable Care Act, and confirmation hearings are underway for Amy Coney Barrett that could swing the court closer to a conservative majority.
Health care reform advocates fear that, if the law is overturned, more than 1.1 million Pennsylvanians could be at risk of losing health care coverage and protections.
More: From the ‘donut hole’ to lifetime limits, here are other key Obamacare provisions in danger
The renewed national debate over the health care law comes at a time of record high unemployment in Pennsylvania and the tri-state region, related to the ongoing COVID-19 pandemic.
The pandemic also has more residents in New York, New Jersey and Pennsylvania seeking coverage in state and federal insurance exchanges or through Medicaid, which was expanded in those states under the Affordable Care Act.
New York State has repeatedly extended a special enrollment period for its insurance exchange this year in response as a result of pandemic-related losses of jobs and employer-sponsored health insurance.
State legislatures in New York and New Jersey have preserved key health law provisions in the event of a repeal.
New York protected coverage for preexisting health conditions and is requiring insurers to provide essential benefits; New Jersey mandated state residents have health insurance or pay a penalty, and imposes a fee on health insurers to help subsidize premiums.
In Pennsylvania, lawmakers have proposed similar legislation to protect some popular aspects of the Affordable Care Act, but a combination of partisan politics and the pandemic have prevented those efforts from moving forward.
Health care advocates and industry leaders warn that a repeal of the federal law without a stop-gap measure would have a devastating human and economic impact in Pennsylvania, which is still struggling to recover amid the ongoing COVID-19 pandemic.
“There is so much economic uncertainty,” said Marc Stier, director of the Pennsylvania Budget and Policy Center, a nonpartisan statewide policy group. “We don’t know how the economy is going to recover from COVID-19.”
In addition to those at risk of losing their health coverage, nearly 1 in 2 Pennsylvanians with pre-existing conditions would lose critical consumer protections, if the health care law is overturned, according to Antoinette Kraus, president of the Pennsylvania Health Access Network.
“That’s just the start of the drastic impacts the lawsuit could have on our health care system,” she added. “The stakes could not be higher.”
‘Catastrophic consequences’
States like Pennsylvania that expanded Medicaid coverage eligibility, and those with high marketplace enrollments, would see the biggest increases in uninsured residents and related economic impact with a repeal of the health care law, according to health care reform experts.
Over the last five years, more than 765,000 Pennsylvanians have been added to the Medicaid rolls as a result of the state expanding eligibility to all adults under age 65 with incomes at or below 138% of the federal poverty level. The threshold this year is $17,236 for one person and $23,335 for a two-person household.
Medicaid enrollment has increased in all 67 Pennsylvania counties since 2009, according to state Department of Human Services data.
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Those newly eligible Medicaid enrollees account for more than one-quarter of the 2.8 million state residents enrolled in Medicaid as of last year, according to the Kaiser Family Foundation, a nonprofit organization focusing on national health issues.
The losses would drive up the state’s uninsured population from 6.4% to 14%, the Urban Institute estimates.
Without the federal dollars to support the Medicaid expansion enrollment, Pennsylvania-run health care program dollars would drop 32%, from $15.8 billion to $10.7 billion, according to the Urban Institute.
Much of that loss would be money used to cover the Medicaid expansion and it’s hard to see how the state could assume those costs, said Stier, of the Pennsylvania Budget and Policy Center.
“The state has no capacity to raise that kind of money now,” Stier said. “I can’t see anyone, certainly in the current Assembly, having the stomach to replace that funding.”
No states have the ability to counter the loss of federal funding, according to one expert on state implementation of the Affordable Care Act.
“No state can make up those subsidies that keep folks covered and guarantee the availability of coverage,” said Katherine Hempstead with the Robert Wood Johnson Foundation in New Jersey.
The economic impact of repealing the health care law on the commonwealth’s economy, on top of COVID-19-related economic losses, would be significant, according to the Economic Policy Institute, which describes itself as an independent nonprofit research organization.
The institute estimated in 2017 that 956,000 Pennsylvanians would lose health coverage, boosting the uninsured ranks 134%, and nearly 32,000 jobs would be lost in the state.
As many as 86,000 people who work in health care could lose their jobs in New Jersey, according to New Jersey Policy Perspective, a progressive think tank in Trenton.
Already, New York state hospitals have lost about a third of their revenue just from the pandemic, according to the Healthcare Association of New York State.
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With more people without health insurance, the state’s struggling health care industry would see uncompensated care costs rise to $3.3 billion, nearly double the current annual losses, according to Urban Institute estimates.
Uncompensated care costs in Pennsylvania dropped 29% between 2014 and 2015 following Medicaid expansion, according to the Pennsylvania Department of Human Services.
The Pennsylvania Hospital and Healthsystem Association predicted a rollback of the health care law would lead to “untold and catastrophic consequences” on the financial stability of the health care community and its consumers, spokeswoman Rachel Moore said.
Moore pointed to an updated financial analysis released last month that shows that between mid-March and July, Pennsylvania hospitals incurred an estimated operating margin shortfall $5 billion below expected results — a 24% drop from pre-pandemic revenues.
The shortfalls “significantly exceed” the federal relief received to date, and losses are expected to continue through 2020 and beyond, according to the report.
A new Pennie
A repeal of the Affordable Care Act would effectively dismantle federal and state insurance marketplaces where people without access to employer-provided plans or Medicaid can purchase policies.
A little more than 300,000 Pennsylvanians this year purchased insurance through the federal government exchange. Nearly 90% received financial assistance with premiums and nearly half received additional assistance with cost sharing, such as copays and deductibles, according to Kaiser.
The end of the exchange system also would have a disproportionate impact on racial minorities in Pennsylvania, according to state and national data.
The uninsured rate among Black and Latino Pennsylvanians has declined significantly since 2013, when it was 15.5% and nearly 23% respectively, compared to nearly 10% of white residents, according to a Pennsylvania State Data Center analysis.
Those uninsured percentages dropped to 7.4% among Blacks and nearly 14% among Latinos, and to 5.7% among the state’s white population as of 2017, the most recent data available.
Racial minorities have a higher participation rate in insurance exchanges than whites in the state, according to an Urban Institute report released last year that examined ACA trends.
The report also found urban areas of Philadelphia and Allegheny, which currently have lower uninsured rates than mid-state counties, also would be disproportionally impacted, the report found.
While financial assistance is available, insurance exchanges have seen significantly higher average premium increase than the employer-sponsored market since they opened in 2014.
The average increase for the second lowest-cost plan on HealthCare.gov — the federal insurance exchange — was 25% from 2016 to 2017, up from 7% the year before, according to a Kaiser analysis. Those “silver” plans are the ones eligible for government subsidies.
With employer plans, the average increase for family coverage in 2016 was 3%, the fifth consecutive year of 3% or 4% premium growth for those plans, according to Kaiser.
The inability to slow costs in the exchanges is the biggest dissatisfaction with the ACA among enrollees who pay the full cost for plans, said Stier of the Pennsylvania Budget and Policy Center.
Republicans efforts to dismantle the health care law has led to instability in the private insurance market, which drives up costs at a faster rate and leads to fewer insurers participating in exchanges limiting plan choices for consumers, Stier said.
Pennsylvania has made progress in stabilizing its individual insurance marketplace in recent years with plan premiums dropping an average of 2.3% last year.
The 2021 premiums are expected to drop further when Pennsylvania transitions to its new online exchange approved earlier this year, instead of participating in the federal exchange. The new exchange, called Pennie, is expected to drop premiums by 5% to 10% for next year.
Pennsylvania will be among 15 states operating fully run state exchanges next year; neighboring New Jersey is also opening one on Nov. 1
The state-based exchange includes a new reinsurance fund, which helps insurers cover their most expensive plan members so they don’t pass the costs to others, which reduces premiums for everyone in the exchange.
Insurers have proposed an overall rate decrease of about 2.6% for exchange plans for 2021 as a result of the reinsurance program. This year the average rate increase was about 3.8%, before subsidies.
The anticipated savings with the state-run exchange would come from a 3.5% user fee that insurers pay on plans sold through the exchange, which is expected to generate $88 million; Pennsylvania will use the money to operate its exchange, which state analysts estimate will cost $30 million a year, and the reinsurance fund.
The Pennie exchange is scheduled to open Nov. 1 through Jan. 15, with an open enrollment period a month longer than it has been in recent years when the state was part of the federal marketplace.
Health care providers and health reform advocates praised the state’s move to operate an independent exchange, though they understand it may close next year.
A ruling from the Supreme Court on the Affordable Care Act is not expected until June 2021, at the earliest. If the law is repealed, anyone who has a plan for 2021 is guaranteed coverage at least through the rest of the year, Pennsylvania Insurance Commission spokeswoman Lindsay Bracale said.
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Sooner or later
Pennsylvania House and Senate Republicans, who control both legislative chambers, have pointed to the 2019 GOP-introduced legislation for the state-run exchange and reinsurance program as an example of bipartisan efforts with health care legislation.
“Rather than work in hypothetical situations of ‘if’ the courts were to act one way or another, our leaders, from both sides of the aisle, worked to strengthen the system for all Pennsylvanians,” said Michael Straub, the House Republican spokesman.
House and Senate Democrats have proposed additional legislation that would preserve critical consumer protection and avoid disruption in the event of a repeal. The series of bills would act as a stop-gap measure by:
- Guaranteeing insurance plans sold in the state would cover the 10 essential benefits in the federal healthcare law. Ensuring Essential Health Benefits, HB469; SB51)
- Prohibiting insurers in the state from using preexisting health conditions to deny coverage or a chance to purchase a policy. (Protecting People with Preexisting Conditions, HB471; SB50)
- Allowing parents the option to add their adult children to their health insurance up to age 26. (Preserving Coverage for Adult Children, HB913; SB982)
- Banning annual or lifetime health insurance coverage limits. (Ending Lifetime Limits on Coverage, HB470; SB939)
But the legislation has been sitting in the House Insurance Committee for more than 10 months without action, said Bill Patton, spokesman for the House Democratic Caucus.
In an effort to force an up-or-down vote on the House floor, Democrats sought to use a discharge resolution, a rarely used method to move legislation when the majority party bottles it up in committee to deny any debate or consideration, Patton said.
More: Wolf: State poised to uphold ACA if courts repeal federal law
Lawmakers were poised to motion and force the vote on Oct. 1, but then the House postponed the session after two lawmakers tested positive for COVID-19, he said.
The House reconvenes on Oct. 19, but with only four scheduled meeting days left in the session, a rule may prohibit Democrats from offering the motion; attorneys are investigating if another option can be pursued to force the vote, Patton added.
In an email, Straub did not respond to questions about whether House Republicans support the proposed bills.
Instead, he pointed out the new state-run insurance exchange will preserve and protect those benefits under the ACA, though he also acknowledged the exchange would work “in coordination” with the existing health care law.
“The scenario you bring up is only hypothetical, and our members continue to work towards solutions to challenges we currently face,” Straub added. “If the ACA is repealed, we will see what actions may be required of the legislature.”
Lindy Washburn, health reporter for the USA TODAY Network New Jersey and David Robinson, health reporter for the USA TODAY Network New York, contributed to this report.
Did you know?
- Originally, the federal health care law required states to expand Medicaid in order to continue to receive federal Medicaid funding. The federal government paid the full cost of Medicaid expansion for the first three years (2014 through 2016), and then the states began to pay a small portion, ramping up to 10 percent by 2020 and remaining at that level going forward. The federal government is responsible for least 90 percent of the cost of covering the newly eligible population under the ACA.
- The total average cost of an U.S. employer family health plan jumped 43 percent between 2008 and 2016, according to the Kaiser Family Foundations (KFF), but that was a much slower rate than the previous eight years when costs jumped 97%.