The ACA lives on, but key parts still face danger

With the failure of the Republican plan to repeal the Affordable Care Act, the law has lived to see another day. But while individuals and families in Pennsylvania can breathe a sigh of relief, serious threats continue.

Of particular concern is an immediate threat to the ACA’s cost sharing reductions that help thousands of Pennsylvanians by lowering their out-of-pocket expenses. Hardworking families continue to struggle with these expenses, especially rising deductibles, which remain a barrier to accessing care. The ACA has brought them relief by giving subsidies to insurance companies in return for reducing this high cost. More than 225,000 Pennsylvanians, almost half of those enrolled in the marketplace, have benefitted. 

During the Obama administration, Republicans in Congress filed a lawsuit to stop the subsidies. The suit is now stuck in court waiting for the current administration to decide whether it will defend them. If the Trump administration fails to act quickly to offer a defense, the payments will stop. The result will be higher out-of-pocket expenses for thousands of lower-income Pennsylvanians. Stopping them could also lead insurance companies to raise premiums and may lead some to leave the market. Congress could help by appropriating money for the subsidies in the upcoming budget and by encouraging the Trump administration to defend them in court.

To see how important the cost sharing reductions can be, meet Roshawn. 

Roshawn Newton, 45, of West Philadelphia is a registered nurse who works as an independent contractor. That means she does not have health benefits from her employer. Not only does she need to stay healthy to help others, she needs to stay healthy to care for her four children.

Prior to the ACA, Roshawn was paying over $550 a month for insurance that covered very little and included a high deductible. Because of the ACA, she now has a plan that costs about half as much and covers all essential benefits. It also includes a cost sharing reduction that reduces her out-of-pocket expenses. If those reductions were eliminated, her cost each time she sees a doctor would nearly double, her annual deductible would be almost five times higher, and on a yearly basis, her expenses could be nearly three times as much. 

She observes: "It's the cost sharing that helps keep my costs manageable. If I had to pay that much more for an office visit, I wouldn't see the doctor. I need that money to raise my children and my children need me."

Essentially, without the cost sharing reductions, even though she would still have an insurance plan, it would be like being uninsured. 

Failure of Congress and the Trump administration to act to preserve the cost sharing reductions would result in increased costs being passed onto hardworking Pennsylvanians like Roshawn. Insurance companies would raise premiums and in some cases stop selling policies all together. We need to put politics aside and stop putting the lives of hardworking Pennsylvanians on the line.


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