Access to Care
ACA Repeal and Replace
Pennsylvania hospitals have been committed to and engaged in health care reform efforts that have reduced the ranks of the uninsured and advanced the Triple Aim—improving overall health and the safety and quality of health care while reducing per capita U.S. health care spending.
Federal policymakers are in the process of reconsidering the Affordable Care Act (ACA).
HAP has produced an interactive state map to help the public and policymakers understand the Affordable Care Act’s health care coverage impact in the state’s Congressional districts.
The hospital community has stood firm in its commitment to coverage and transformation. As such, any alternative to the ACA must:
- Ensure continuity of coverage and care through access to a robust, competitive delivery system
- Ensure stable and sufficient funding for hospitals
- Maintain momentum in delivery system transformation and innovation
Leading into the 115th Congress, the Republican-controlled Congress and the incoming Trump Administration pledged to take swift action to repeal the ACA. Those advocating for repeal have cited key areas of concern with the law including federally imposed mandates, instability and rising prices under the health insurance marketplaces, and a greater role and financial responsibility of the federal government in health insurance coverage.
Congress is grappling with how to approach repealing the law, and what alternative health care reform policies to pursue.
Policy concepts to address coverage and Medicaid reform that have been contemplated by Republican policymakers include:
- Market-oriented, consumer-driven mechanisms to expand coverage such as health savings accounts and refundable tax credits
- Insurance Market Reforms—retaining some of the consumer protections of the ACA, or attempting to achieve similar means through alternative policies
- High-risk pools and default options for the uninsured
- Tax Treatment of Employer-Sponsored Coverage—replacing the current Cadillac tax with a cap on the exclusion for employer-sponsored insurance
- Medicaid Reform—proposals to block grant or provide a per-capita allocation, and reform through waivers
Pennsylvania hospitals face significant implications if repeal is not coupled with adequate replacement policies:
- Coverage: 1.1 million Pennsylvanians have benefit from health care coverage through the health insurance marketplace, Medicaid expansion, and dependent coverage. More than 412,000 Pennsylvanians have gained health insurance coverage through the marketplace, with 78 percent relying on subsidies, and from 2013 to 2016, 685,000 Pennsylvanians have secured coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Millions of Pennsylvanians have also benefited from consumer protections secured as a result of the ACA—coverage for patients with pre-existing conditions, no lifetime limits, a minimum essential benefits package.
- Funding to support care: A report, issued by the American Hospital Association (AHA) and Federation of American Hospitals, details the impact ACA repeal would have on hospitals and health systems nationwide. ACA-mandated hospital cuts will amount to $14.9 billion for Pennsylvania hospitals for the period of 2018 to 2026. Hospitals will need that funding to address the additional uncompensated care that will result from growing numbers of uninsured patients.
ACA IMPACT – INFORMATION AND RESOURCES
HAP President and CEO Andy Carter Letter to Pennsylvania Delegation (Download PDF)
SUMMARY: The American Health Care Act (Download PDF)
PRESENTATION: The American Health Care Act: Policy and Implications (Download PDF)
Analysis of the CBO Report and Implications for Pennsylvania (News Article)
AHA Letter to Members of Congress on AHCA (Download PDF)
Report Card Health Care Transformation in PA (Download PDF)
PRESENTATION | Fundamentals of Medicaid (MS PowerPoint)
INFOGRAPHIC | Repealing the ACA: Coverage Consequences (Download PDF)
Regional Economic Impact of Pennsylvania Hospitals and Health Systems (Download PDF | MS PowerPoint)
POSITION PAPER: Coverage Consequences (Download PDF)
POSITION PAPER: Eliminating Medicaid Expansion (Download PDF)
POSITION PAPER: Medicaid Financing Reform (Download PDF)
POSITION PAPER: Health Care Transformation (Download PDF)
Health Care Transformation
By the Numbers: Health Care Transformation in PA (Download PDF)
Health Care Transformation in Pennsylvania Before and During the Affordable Care Act (ACA) (Download PDF)
MAP | Projected Regional Economic Impact of Medicaid Expansion in 2016 (Download PDF | MS PowerPoint)