Full repeal of the Affordable Care Act would lead to over 850,000 Pennsylvanians losing their health insurance. Yet, this week, the Trump administration is calling on a federal court to declare the ACA unconstitutional.
The Affordable Care Act (ACA) of 2010 has had a tremendous impact on the state of health care in Pennsylvania. Since its roll-out, the number of Pennsylvania residents with health insurance has increased and the uninsured rate declined considerably. This has been achieved primarily through two key parts of the ACA: Medicaid expansion and the tax credit subsidies for health care exchanges.
The expansion of Medicaid began in 2015, providing benefits to individuals and families up to 138% of the federal poverty line. Prior to expansion, only disabled or very low-income parents of dependent children qualified for Medicaid. As of November 2018, 692,047 people were enrolled in expanded Medicaid in Pennsylvania.
Health care exchanges reduce the cost of health insurance for those with incomes between 138% and 400% of the federal poverty line. As of February 2017, more than 426,000 Pennsylvanians had signed up for health care in 2017 through the exchanges. (In 2016, it was 412,347 people.) About 75% of returning marketplace consumers in 2017 were able to find health insurance for less than $100 a month as a result of the exchanges and tax credits that make insurance more affordable.
Despite the positive impact the ACA has had in terms of shrinking the uninsured population, its future remains uncertain. In a recent court case in the Northern District of Texas, the U.S. District Court ruled in favor of the plaintiffs who argued that the entire Affordable Care Act should be invalidated because the individual mandate was eliminated in the 2017 Tax Cuts and Jobs Act. The repeal, however, has been stayed until a decision is made on appeal to the US Court of Appeals for the Fifth Court. Recently, the Trump administration argued in a legal file that the entire law should be repealed, including the provision protecting those with preexisting conditions.
What would full repeal of the Affordable Care Act mean for Pennsylvania? An Urban Institute report released in March 2019 quantifies the impact on states’ health coverage, federal and state funding, and uncompensated care with a full repeal of the ACA. Below we summarize the Urban Institute’s findings and discuss the potential impacts of eliminating other provisions of the ACA. 
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An earlier analysis of ACA repeal that draws on partly different data but reaches the same overall conclusion is Marc Stier, Devastation, Death, and Deficits: The Impact of ACA Repeal on Pennsylvania, January 19, 2017 https://www.krc-pbpc.org/wp-content/uploads/Impact_ACA_Repeal_Final_Revised.pdf.