Pennsylvania Gov. Tom Wolf did not mince words in a recent letter to House Speaker Paul Ryan.
“This is not hyperbole — access to treatment through Medicaid is keeping Pennsylvanians alive who might otherwise face overdoses or worse,” wrote Wolf, a Democrat, to Congress’ top Republican leader.
Government officials and politicians on both sides of the aisle in Pennsylvania are warning that a repeal of the Affordable Care Act, better known as Obamacare, would have disastrous consequences in the state — one that has been especially stricken by the nation’s opioid crisis amid a messy state budget outlook.
Pennsylvania, like many states, has benefitted from numerous ACA programs, which have provided significant funds for state medical programs and expanded insurance coverage in the state.
Overall, 479,000 Pennsylvanians have gained insurance coverage through the ACA-established individual markets or the law’s provision that allows children to stay on their parents’ coverage until 26, the Department of Health and Human Services (HHS) reported in December.
In 2015, Pennsylvania joined 31 other states and the District of Columbia in taking advantage of the Medicaid expansion provision in the ACA, which provided states funds to expand Medicaid to any any adult living under 138% of the federal poverty level — an income of $US27,821 for a family of three in 2016. Through the expansion, 670,000 people have gained coverage.
All in all, that’s more than 1 million Pennsylvanians who could be affected by what happens in Washington.
“There would be no way for the state to continue to provide health care for those folks,” Ted Dallas, secretary of Pennsylvania’s Department of Human Services, told the Pittsburgh Post-Gazette last month. “Repeal without replacement would have potentially devastating impacts across the state.”
President Donald Trump campaigned hard for a repeal of the ACA, calling it a “mess” repeatedly and promising to “repeal and replace” it. With Trump in office, Republicans have begun the lengthy and complicated process to repeal, replace, or at least significantly revise the law.
In mid-January, Congress passed a budget resolution directing the legislature to draft a repeal and replacement to the ACA. With a simple majority vote, lawmakers could eliminate or radically change the Medicaid expansion and funding for subsidies on the individual market.
A loss in funds would be particularly devastating for Pennsylvania, which is currently suffering a $US600 million budget shortfall as of December and could go as high as $US1.7 billion by July, according to the Pittsburgh Post-Gazette.
A report from the Pennsylvania Budget and Policy Center, a liberal-leaning think tank, estimated that the deficit could grow by an additional $US1.4 billion after an ACA repeal, due to the loss in federal funding and subsidies.
The same report found that 137,000 workers in healthcare, construction, and other sectors would lose their jobs due to a repeal.
I’m really, really worried about what’s happening in Washington. And I say that as a Republican. — Pennsylvania Republican State Rep. Gene DiGirolamo
Pennsylvania Republican State Rep. Gene DiGirolamo told Business Insider that if a repeal eliminates coverage for all or some of the Pennsylvanians that have gained it through the ACA, it will fall back on the state to treat them in hospitals and emergency rooms. That makes DiGirolamo very nervous because, he said, there are “no extra dollars” to insure residents who lose coverage due to a repeal.
“There is not a whole lot we can do with the budget situation we’re in,” DiGirolamo said.
Pennsylvania Auditor Gen. Eugene DePasquale and Treasurer Joe Torsella warned in a joint press conference in January that a repeal or even a rollback would have reverberating consequences across the state, both in terms of job losses and the state budget.
“It will exacerbate an already difficult and troubled budget situation,” Torsella said.
‘A disaster’ waiting to happen
Compounding discussions about the future of healthcare in Pennsylvania is the state’s opioid crisis.
Pennsylvania — which has the sixth-highest drug-overdose death rate in the US, at 26.3 deaths per 100,000 people — is providing substance-abuse treatment to 63,000 of those patients thanks to the Medicaid expansion, according to official figures released last month.
Wolf, the state’s governor, has lauded the expansion as opening “the door to treatment” that otherwise would not be available — much less affordable — to those without insurance.
And DiGirolamo said that his biggest worry with a repeal is doing away with the Medicaid expansion, which he says “would be a disaster.”
Without the expansion, the vast majority of those people would either fall into the “treatment gap” — unable to receive substance-use treatment because of a lack of insurance or public funds — or be forced to wait months or years to get into a publicly funded treatment program.
Losing the Medicaid expansion would have a far wider effect for addicts than just the 63,000 people currently receiving treatment in the state, DiGirolamo said.
In Pennsylvania, the Department of Drug and Alcohol Programs (DDAP) allocates federal and state dollars for substance abuse treatment to Single County Authorities (SCA), organisations in each county that work on the ground to provide services to people in need.
Prior to the ACA, says DiGirolamo, the SCAs were constantly underfunded and therefore unable to provide treatment for all those suffering — a major issue for a state in the midst of a drug epidemic. Because the ACA opened up eligibility for Medicaid to a lot of people in need, who then received coverage for treatment through the program, less people have looked to the SCAs for aid. It has freed up considerable funds to reduce the treatment gap.
DiGirolamo worries that the elimination of the Medicaid expansion could wreak havoc on those funds.
“Medicaid has taken enormous pressure off of our counties,” DiGirolamo said. “I don’t know what our counties would do if [the federal government] took away the expanded Medicaid program.”
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