Pennsylvania has 1M in path of Obamacare repeal

If president-elect Donald Trump and a Republican-controlled Congress repeal Obamacare as they promised, more than 20 million Americans — including about a million Pennsylvanians — could lose their health insurance.

Congressional Republicans have been trying to repeal the federal Affordable Care Act since it was passed six years ago, even as millions of Americans signed up for subsidized health plans on the law's insurance marketplace and enrolled in expanded state Medicaid programs. When repeal proposals reached President Obama's desk, he vetoed them.

Some of the latest proposals, which could be revived when Trump reaches office, would reverse the Medicaid expansion and eliminate the subsidies. Changes outlined in a proposal that both houses of Congress passed early this year would cut an estimated 22 million people from insurance, according to Congressional Budget Office estimates.

“I don't think we've seen anything on this scale,” said Julie Donohue, an associate professor of health policy and management in the University of Pittsburgh's Graduate School of Public Health. “... It would be unprecedented.”

The estimate includes people who have coverage through Medicaid and the Children's Health Insurance Program, employer-based plans and individual plans bought on the federal marketplace or directly from insurers, according to the CBO analysis of the legislation Congress passed, known as HR 3762. The changes would decrease deficits by about $474 billion from 2016 to 2025, according to the estimates.

In Pennsylvania, about 700,000 people have gained access to Medicaid since the federal law raised the income levels for eligibility. Another 412,000 have individual plans bought on the federal marketplace at healthcare.gov.

Trump has denounced the law in strong terms while citing the need to replace it.

“If we don't repeal and replace Obamacare, we will destroy American health care forever,” he said last week in a speech outside Philadelphia.

Trump has seized in recent weeks on headlines describing double-digit premium increases for marketplace plans in states across the country. Major insurers such as Aetna and UnitedHealthcare have exited the federal marketplace, saying sicker-than-expected members were driving heavy losses as fewer young, healthy people signed up for the plans than expected.

Replacing the law could reduce the number of people who would lose their insurance.

Trump, in an outline of a replacement plan on his website, calls for creating a tax deduction to help with monthly premiums, promoting expanded use of health savings accounts and allowing insurers to sell health plans across state lines, along with eliminating the law's requirement that most people have insurance.

His proposal would give state Medicaid programs annual blocks of money to spend at their discretion instead of obligating the federal government to pay a portion of treatment costs. The proposal calls for a review of Medicaid to “ensure that those who want health care coverage can have it.”

The outline doesn't address major policy questions, such as whether insurers would be able to adjust premiums based on consumers' pre-existing medical conditions. The health law forbids insurers from denying coverage or setting rates based on health condition, a common practice before its passage.

Insurers are unlikely to continue covering people at equal rates regardless of medical condition if there is no mandate for everyone to have insurance, Donohue said.

“There's a lot of uncertainty,” said Antoinette Kraus, executive director of the consumer group Pennsylvania Health Access Network. “Are we really going to go back to a time when insurance companies can deny people care with pre-existing conditions?”

Kraus said her group continues to encourage people to sign up for marketplace plans and Medicaid to ensure coverage.

“I still don't believe something is going to happen overnight,” she said. “We'll see how it plays out, but it's hard to imagine what could happen if one million Pennsylvanians lose coverage.”

Some replacement proposals aim to encourage enrollment through incentives — such as tax deductions to help with premium costs — instead of penalizing people who go without insurance, said Jeffrey Anderson, a senior fellow at the Hudson Institute, a conservative Washington-based think tank.

Tax credits have been available for employer-based insurance for decades, he and other experts said, but not for individuals.

“I think we're about 70 years overdue for offering a tax break for people who buy insurance on their own,” he said.

Hudson has crafted a replacement proposal that he said would provide $1,200 per year in tax deductions for people younger than 35; $2,100 per year for those ages 35 to 50; $3,000 for those older than 50; and $900 for children.

U.S. Rep. Keith Rothfus, R-Sewickley, said Congress intends to act swiftly.

“With a Republican president and Republicans in control of Congress, we have a clear mandate from the American people to repeal and replace Obamacare with a health care bill that actually works for American families,” he said in a statement Wednesday. “This failed law has caused premiums and deductibles to skyrocket, and it is imploding before our eyes.”

Rothfus said the Republican plan will translate to “lower costs, higher quality coverage and a stronger Medicare.”

He added: “We will accomplish this through competition and consumer choice — not through centralized control in Washington.”

Nuket Curran, 45, of Shaler hasn't been thrilled with the high cost of her Obamacare plan for her family of four. Still, she fears the unknown that comes with Trump's victory.

“It's better to have something than nothing,” said Curran, who owns a physical therapy business. “What the heck will my option be come January? What will be available for my family?”

Curran, who worked 11 years for UPMC, opened her business in May and shopped around with the help of a broker for the best plan under the Affordable Care Act. She opted for coverage under the silver plan for UPMC Health Plan, which she said totals about $650 a month.

“It helps me sleep at night, knowing I have coverage,” said Curran, who has two young sons. “I'll be curious to see what the Republicans have to offer, but I am also very worried.”

Wes Venteicher and Ben Schmitt are Tribune-Review staff writers. Reach Venteicher at 412-380-5676 or wventeicher@tribweb.com. Reach Schmitt at 412-320-7991 or bschmitt@tribweb.com.