House lawmakers had the opportunity to advance legislation that would have enshrined ACA provisions into state law. They punted the bills to another committee instead.
More than 10 years after the Affordable Care Act was enshrined into law, the landmark healthcare bill is once again at risk of being repealed in a lawsuit that could pose a particular threat to hundreds of thousands of Pennsylvanians.
A coalition of 18 Republican-led states are suing to repeal the ACA in a case set to be heard by the U.S. Supreme Court this fall. Pennsylvania is not involved in the case, but still has a significant stake in the proceedings, as the state would experience the eight highest percentage decrease in health insurance coverage in the nation if the ACA were struck down.
More than 850,000 Pennsylvanians would lose their coverage in this scenario, according to a 2019 study from the Urban Institute. Those numbers are likely to be even higher now, as more than 1.1 million newly-uninsured Pennsylvanians have become eligible for coverage via the ACA or the state’s expanded Medicaid program during the coronavirus pandemic.
The public health programs, which have long been shown to be a lifeline to struggling Americans, have become even more critical during the coronavirus pandemic, providing Pennsylvanians with one of the only options of affordable insurance coverage. If the ACA were to be repealed, those Pennsylvanians would be left with few options, as President Trump and his Republican allies in the Senate have failed to propose any meaningful replacement.
“The overturn of the Affordable Care Act would be disastrous for Pennsylvanians’ access to healthcare, as it could mean the end of both Medicaid expansion and the marketplace,” said Antoinette Kraus, executive director of the Pennsylvania Health Access Network.
“The overturn of the Affordable Care Act would be disastrous for Pennsylvanians’ access to healthcare, as it could mean the end of both Medicaid expansion and the marketplace.”
Even those Pennsylvanians with private coverage would suffer in a world without the ACA. The law guarantees coverage for the more than 5 million Pennsylvanians who live with pre-existing conditions and requires insurers to cover essential benefits, such as prescription drugs and chronic disease management. The ACA also bans annual or lifetime dollar limits on these benefits, which prevents insurers from denying care to those with chronic conditions. This measure has helped 4.5 million Pennsylvanians, according to the state’s own department of insurance.
State lawmakers, Kraus said, need to codify these consumer protections into law. “At least 17 other states have already taken some action to establish protections at the state level. Pennsylvania has not,” she noted.
Pennsylvania Democrats tried to do just that in April, pushing to pass four previously introduced bills to enshrine the ACA’s provisions into state law:
- HB 471, which would ban insurers from denying coverage to those with pre-existing conditions, even if the ACA is eliminated.
- HB 469, which would require insurance policies sold in the state to cover 10 essential benefits, including hospitalization, prescription drug costs, and maternity care.
- HB 470, which would prohibit annual or lifetime dollar limits on essential health services
- HB 193, which would allow an insured employee of a group health plan to provide coverage to their adult child up to the age of 26.
House Democratic Leader Frank Dermody (D-Allegheny) said the legislation was all the more critical because of the way COVID-19 had devastated the state.
“Almost 50,000 of our Pennsylvania neighbors and family already contracted COVID-19, meaning they now have a pre-existing condition,” Dermody said in an April statement (the number of COVID-19 cases in the state has since risen to nearly 77,000). “If the federal courts take away the ACA law, anybody with this diagnosis could be denied coverage. At a time like this, people need health security more than anything else.”
The bills, which had sat with the House Committee on Insurance for more than a year, were shelved on party-line votes in April. Every Republican on the committee voted to re-refer all four bills to the House Health Committee, effectively killing the Democratic effort.
Rep. Wendi Thomas (R-178) was among the committee members who voted against the bills. The former healthcare industry executive, however, is a proponent of trying to force Gov. Tom Wolf to lift coronavirus restrictions sooner, even as the pandemic continued to spread across the state.
On Tuesday, Thomas voted in support of ending the coronavirus emergency declaration order, which, Republicans argue, would allow businesses to reopen without restrictions. The governor’s office, though, said the resolution has no authority when it comes to the state’s reopening plan. Instead, terminating the order would, among other things, limit Pennsylvanians’ access to health care by ending tele-health and other healthcare services provided by out-of-state providers, according to the administration.
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With the threat of the repeal of the ACA looming, Kraus criticized Republicans’ decision in April to reject legislation that would protect Pennsylvanians’ access to healthcare.
“The legislature has yet to take action to make sure that Pennsylvanians will have critical consumer protections if all or part of the Affordable Care Act is overturned,” she said. “We have called on the General Assembly to take action on this, and we believe it’s a critical step to protecting the many Pennsylvanians who would be impacted by the overturn of the ACA.”
Losing the benefits provided by the ACA during a pandemic would be especially devastating for Pennsylvanians, Kraus continued. “Testing and treatment for coronavirus is covered under the ACA’s preventive health and essential health benefits provisions,” she said. “The consumer protections are also even more critical; people with pre-existing conditions like immune [system] suppression, cancer, or breathing conditions—those who are most susceptible to coronavirus infection—cannot be excluded, charged more or denied treatment because of the ACA’s consumer protection provisions.”
She emphasized that without the safety net the ACA provides, those who’ve lost their jobs due to the pandemic would also struggle to get health insurance, which would have negative consequences for all state residents. “At a time when we want people to get tested and treated immediately for COVID-19, we simply can’t afford to make it harder for people to access care; it makes us all less safe.”