Health Reform Facts: Pennsylvania

DEMOGRAPHY
The Patient Protection and Percent of Population in Pennsylvania per Race / Ethnic Group 2
Affordable Care Act (ACA) was
enacted on March 23, 2010.
Successful implementation requires
cooperation between key 4.8 2.6
stakeholders, federal and state
agencies, and reform advocacy
organizations. Because the fifty 10.8
states vary greatly, each state’s
White (Non Hispanic)
implementation process will be
unique. Black
Hispanic

In 2009, Pennsylvania had the sixth Other*

largest population in the United 81.4
States, estimated to be
12,604,767. 1 While the state’s
population is primarily White, there
are communities with substantial
racial diversity, which will present
Pennsylvania with varying
challenges as it strives to * Others include American Indian & Alaska Native, Asian, and Native Hawaiian and other
implement health reform that Pacific Islanders.
works for all residents.
PENNSYLVANIA AND THE UNINSURED: HOW WILL THE AFFORDABLE CARE ACT HELP?
While 90.2% of all Pennsylvanians have health insurance, over 1.1 million individuals remain uninsured, 3
including about 7.6% of Pennsylvania’s children 4 and 11% of the state’s working population. 5

ACA is designed to address these concerns by providing affordable access to health insurance coverage to
those individuals who would otherwise be unable to obtain coverage, and to extend current benefits and
services provided by Medicaid (Pennsylvania's Medicaid program, Medical Assistance, is a federal and state
funded public insurance program that provides health insurance coverage for low-income and disabled
individuals and families).
NEW BENEFITS UNDER ACA: THE EFFECTS IN PENNSYLVANIA
Insurance ACA establishes new requirements for private health insurers in order to make health care
Coverage plans more accessible to the public. These requirements include the following:

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National Coalition on Health Care July 2010
  Effective Immediately: Plans must cover certain preventive health services, such as
vaccines and screenings, without a co-pay.
 Effective September 2010:
o Insurers will not be allowed to drop any insured person because he/she gets sick
or develops a chronic health condition. In addition, ACA allows individuals to
renew health insurance coverage regardless of their health status.
o Individuals up to the age of 26 can choose to be covered under their parents’
insurance plan.
 Effective January 2014:
o Under the “guaranteed issue” provision, an insurer must accept every employer
and individual in the state that applies for coverage.
o Insurers cannot exclude people from coverage if they have a pre-existing
condition (e.g., asthma, diabetes, or any other long-term condition) or past illness.
o All insurers will be required to offer a coverage package that offers essential
benefits.
Effective Immediately: ACA makes tax credits available to qualifying small businesses to help
Small
them afford coverage for their employees. These tax credits could total up to 50% of a
Business
business’ health insurance premiums. In 2008, Pennsylvania had over 190,000 small
Assistance
employers, 6 which represented over 74% of the state’s employers.7
Effective January 2014: ACA provides a tax credit to qualified individuals so that they may
Tax Credits purchase health insurance through the exchanges. Qualification for the tax credit will be
for based on the individual’s household income and his/her number of dependents. A person
Individuals who earns between 133% and 400% of the federal poverty level 8 may be eligible for
individual tax credits.
Effective January 2014: ACA requires that states create an insurance market “exchange” – a
Health
marketplace where people will be able to compare and shop for health insurance. This will
Insurance
make access to health plans easier and more efficient. U.S. citizens, legal immigrants, and
Exchanges
small businesses will be able to purchase insurance through these exchanges.
Effective July 2010: High-risk pools are designed to provide health insurance coverage to
High-Risk people who were previously uninsurable due to a pre-existing condition. Pennsylvania does
Insurance not have its own high-risk insurance program. However, Pennsylvania started running its
Pools federally funded high-risk pool on August 4, 2010. 9 The program may provide services to
3,500 Pennsylvanians per year. 10
Effective January 2014: ACA contains provisions that would create new eligibility
requirements for Medicaid. For example, adults under the age of 65 earning less than 133%
Expansion of the federal poverty level, may be eligible to apply regardless of whether they have
of children. It is estimated that approximately 480,000 Pennsylvanians may be able eligible to
Medicaid join Medicaid. 11

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National Coalition on Health Care July 2010
 IMPLEMENTATION CHALLENGES IN PENNSYLVANIA
Successful implementation of ACA will require a joint effort among local, state, and federal agencies, as
well as many non-governmental organizations. The State of Pennsylvania will face several challenges:
 Budget 12 – In the proposed budget for Pennsylvania's Fiscal Year 2010-2011, Gov. Ed Rendell assumed
that Congress would pass enhanced Medicaid funding. Without such passage, the state's budget gap
could become $2.4 billion in 2011 and result in severe program cuts and employee terminations. The
limited budget in Pennsylvania will be a challenge for implementation.
 Health Care Workforce – With the potential increase of Pennsylvania's insured population, it is
important that primary care physicians and other necessary health care professionals are engaged in
health care reform. ACA provides grants and loan forgiveness to health care professionals; this will help
Pennsylvania ensure that it has an appropriate supply of doctors, nurses, social workers, and other
professionals to cover the increased demand.
 State Lawsuit - Despite support for ACA from Governor Ed Rendell, Pennsylvania's Attorney General
Tom Corbett has joined the multistate lawsuit challenging the constitutionality of ACA. The outcome of
the lawsuit, combined with the gubernatorial election, will have a great effect on implementation in
Pennsylvania.

1
U.S. CENSUS BUREAU, STATE AND COUNTY QUICKFACTS (2010), available at http://quickfacts.census.gov/qfd/states/42000.html (last accessed
June 2010). These figures are from 2009.
2
Ibid. These figures are from 2008.
3
THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured
estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic
Supplements), available at http://www.statehealthfacts.org:/comparetable.jsp?ind=125&cat=3 (last accessed June 2010).
4
THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured
estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic
Supplements), available at http://www.statehealthfacts.org:/comparetable.jsp?ind=127&cat=3 (last accessed June 2010).
5
COVER THE UNINSURED, ROBERT WOOD JOHNSON FOUNDATION, U.S. UNINSURED WORKERS, available at
http://covertheuninsured.org/uninsured_workers#map (last accessed June 2010). These figures are from 2006-2007.
6
Small businesses include employers with fewer than 50 employees.
7
U.S. DEP’T OF HEALTH & HUMAN SERVS. MEDICAL EXPENDITURE PANEL SURVEY (2008), available at
http://www.meps.ahrq.gov/mepsweb/data_stats/summ_tables/insr/state/series_2/2008/ic08_iia_f.pdf (last accessed June 2010). These
figures are from 2008.
8
The federal poverty level for the 48 contiguous states is $10,830 for a single individual. ASSISTANT SEC'Y FOR PLANNING AND EVALUATION, U.S.
DEP’T OF HEALTH & HUMAN SERVS. THE 2009 HHS POVERTY GUIDELINES (2010), available at http://aspe.hhs.gov/poverty/09poverty.shtml (last
accessed June 2010).
9
PENNSYLVANIA INSURANCE DEP'T. Pennsylvania to Begin Offering Health Plan for People with Pre-Existing Medical Conditions, (Aug. 2, 2010),
http://www.portal.state.pa.us/portal/server.pt?open=512&objID=17319&PageID=502655&mode=2&contentid=http://pubcontent.state.
pa.us/publishedcontent/publish/cop_hhs/insurance/news_and_media/news___media/articles/august_2__2010.html (last accessed
August 2010).
10
Ibid.
11
JOHN HOLAHAN & IRENE HEADEN, KAISER COMMISSION ON MEDICAID AND THE UNINSURED, MEDICAID COVERAGE AND SPENDING IN HEALTH REFORM: NATIONAL
AND STATE‐BY‐STATE RESULTS FOR ADULTS AT OR BELOW 133% FPL 41 (2010), available at http://www.kff.org/healthreform/upload/Medicaid-
Coverage-and-Spending-in-Health-Reform-National-and-State-By-State-Results-for-Adults-at-or-Below-133-FPL.pdf (last accessed June
2010).
12
BRAD BUMSTED and EVAN TROWBRIDGE, Medicaid Funding Loss to Hurt Pennsylvania. PITTSBURGH TRIBUNE-REVIEW, (June 5, 2010), available at
http://www.pittsburghlive.com/x/pittsburghtrib/news/s_684597.html (last accessed June 2010).

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National Coalition on Health Care July 2010