Regular Session 2017-2018 House Resolution 0181 P.N. 1063

PRINTER'S NO. 1063

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE RESOLUTION

No.

181

Session of

2017

INTRODUCED BY DeLUCA, DERMODY, HANNA, MARKOSEK, FRANKEL,

YOUNGBLOOD, GOODMAN, BOYLE, BARBIN, BRADFORD, BULLOCK,

CARROLL, CEPHAS, COMITTA, P. COSTA, CRUZ, DALEY, DAVIDSON,

DAVIS, DEAN, DeLISSIO, DONATUCCI, DRISCOLL, FABRIZIO,

FITZGERALD, FREEMAN, GAINEY, GERGELY, J. HARRIS, HILL-EVANS,

KAVULICH, KIM, KINSEY, KIRKLAND, KRUEGER-BRANEKY, KULIK,

MADDEN, MATZIE, McCLINTON, McNEILL, D. MILLER, NEILSON,

O'BRIEN, RABB, SAMUELSON, SCHLOSSBERG, SCHWEYER, SIMS,

SOLOMON, STURLA, THOMAS, VITALI, WARREN, BRIGGS, V. BROWN,

D. COSTA, DAWKINS, DEASY, FLYNN, HARKINS, W. KELLER, MULLERY,

PASHINSKI, RAVENSTAHL, ROEBUCK AND WHEATLEY, MARCH 22, 2017

REFERRED TO COMMITTEE ON INSURANCE, MARCH 22, 2017

A RESOLUTION

Urging the President and the Congress of the United States to

not repeal the Patient Protection and Affordable Care Act.

WHEREAS, In 2010, the Congress of the United States passed

and then President Barack Obama signed the Patient Protection

and Affordable Care Act (Public Law 111-48, 124 Stat. 119),

known as the Affordable Care Act or the ACA; and

WHEREAS, Often referred to as Obamacare, the Affordable Care

Act (ACA) established a comprehensive series of health insurance

reforms designed to make universal, affordable health insurance

coverage available to all Americans while controlling rising

health care costs and ending certain insurance industry

practices that limited access to health coverage; and

WHEREAS, Specifically, provisions of the ACA expand access to

health insurance coverage by creating transparent health

insurance marketplaces or health insurance exchanges, allow

young adults to stay on their parents' health plans until age

26, expand Medicaid and establish a system of tax credits and

penalties designed to encourage consumers to purchase individual

coverage and to incentivize businesses to provide coverage to

their employees; and

WHEREAS, A key provision of the ACA requires all health

insurance plans sold in the health insurance marketplace, non-

marketplace plans, small group plans and Medicare and Medicaid

to provide coverage for 10 Essential Health Benefits; and

WHEREAS, The Essential Health Benefits have established a

vital floor for health insurance coverage nationwide with no

annual dollar caps, providing older and working Pennsylvanians

and their families and individuals with mental health challenges

or substance use disorders more health care benefits and a

lesser financial burden; and

WHEREAS, The Essential Health Benefits embodied in the ACA

include, but are not limited to, preventive care, emergency

services, hospitalization, prescription drug coverage, pediatric

services, maternity and newborn care and mental health and

addiction treatment services; and

WHEREAS, The ACA further authorizes three types of financial

assistance to help people afford health insurance coverage:

Medicaid expansion for people with incomes below 138% of

poverty, refundable premium tax credits for people with incomes

from 100% to 400% of the poverty level who purchase health

insurance coverage through Federal or State marketplaces, cost-

sharing subsidies for people with incomes from 100% to 250% of

poverty to provide lower deductibles and copays when purchasing

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silver plans in the marketplace; and

WHEREAS, The ACA has established a mechanism for consumers to

appeal coverage determinations; and

WHEREAS, The ACA has established a system of navigators to

assist consumers in navigating the health insurance marketplace;

and

WHEREAS, The ACA provides incentives to increase the number

of primary care doctors, encourages primary care doctors to

practice in medically underserved rural and urban areas,

promotes alternative payment methodologies designed to improve

the value of medical care and works to link patients with

community-based resources and other services designed to reduce

unnecessary hospitalizations and use of emergency departments;

and

WHEREAS, The ACA has modified Medicare by slowing the growth

of payment rates to hospitals and other health care providers,

reducing payments to Medicare Advantage plans and improving

benefits for enrollees; and

WHEREAS, The Commonwealth of Pennsylvania is one of 28 states

that participate in the ACA through a federally facilitated

Health Insurance Marketplace; and

WHEREAS, Since full implementation of the ACA in 2015, United

States Census data reveal that the Commonwealth of

Pennsylvania's uninsured rate decreased from 10.2% in 2010 to

6.4% in 2015; and

WHEREAS, According to the Insurance Department of the

Commonwealth of Pennsylvania, more than 412,347 Pennsylvanians

enrolled in marketplace plans in 2016; and

WHEREAS, Of those enrollees, 78% received financial

assistance at an average of $248 per month to offset premium

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costs; and

WHEREAS, Because of the financial assistance authorized under

the ACA, Pennsylvanians in the individual marketplace received

nearly $1 billion in premium subsidies in 2016; and

WHEREAS, The Insurance Department of the Commonwealth of

Pennsylvania reported that as of February 2017, more than

426,000 Pennsylvanians had signed up for health insurance

coverage in the health insurance marketplace for 2017; and

WHEREAS, In the case of Medicaid enrollment, the Insurance

Department of the Commonwealth of Pennsylvania reports that more

than 700,000 Pennsylvanians have received health insurance

coverage through Medicaid expansion since implementation in

January 2015 and that every county in the Commonwealth of

Pennsylvania experienced an increase in Medicaid enrollment

ranging from 14% to 28%; and

WHEREAS, Medicaid expansion has enabled the Commonwealth of

Pennsylvania to provide essential drug and alcohol treatment to

more than 124,000 Pennsylvanians; and

WHEREAS, More than 51,000 Pennsylvanians have access to

substance use disorder treatment through coverage obtained

through the Federal marketplace, thereby assisting in the

Commonwealth of Pennsylvania's fight against the opioid and

heroin epidemic; and

WHEREAS, Due to the ACA, nearly 1.1 million Pennsylvanians or

more than 10% of Pennsylvanians under 65 years of age, including

thousands of working Pennsylvanians who reside in every county

in the Commonwealth of Pennsylvania, have health insurance

coverage; and

WHEREAS, Data compiled by the Pennsylvania Cost Containment

Council revealed that uncompensated care for the Commonwealth of

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Pennsylvania's general acute care hospitals increased every year

from 2001 until 2015 but was reduced by 8.6% or $92 million in

2015 after implementation of Medicaid expansion; and

WHEREAS, By 2016, uncompensated care for the Commonwealth of

Pennsylvania's general acute care hospitals was reduced by

approximately $280 million because of Medicaid expansion; and

WHEREAS, In 2015, nearly 297,000 seniors in the Commonwealth

of Pennsylvania saved approximately $1,000 on prescription drugs

because of ACA provisions that closed the Medicare donut hole,

totaling $313 million in savings for older Pennsylvanians; and

WHEREAS, If the Commonwealth of Pennsylvania had not opted to

expand Medicaid, the Commonwealth would have forfeited $37.8

billion in Federal funds over the next 10-year period for the

benefit of older and working Pennsylvanians, their families and

individuals with mental health or substance use disorders; and

WHEREAS, The ACA has had a positive impact on the

availability and affordability of health insurance coverage and

access to health care in the Commonwealth of Pennsylvania since

2015, as evidenced by the decline in the uninsured rate for non-

elderly adults from 11.7% in 2014 to 8.7% in 2015; and

WHEREAS, There has been a corresponding increase in the

number of health care providers, receipt of more than $1.8

billion in payments by health care providers for treating new

Medicaid enrollees, a $2.2 billion increase in economic output,

the addition of an estimated 15,500 private sector jobs, mostly

in the health care field, and generation of an estimated $53.4

million in State tax revenue; and

WHEREAS, Although the Commonwealth of Pennsylvania's

experience from ACA implementation through Medicaid expansion

and a federally facilitated health insurance exchange has had a

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positive impact on the ability of working Pennsylvanians to

afford health insurance coverage, millions of working

Pennsylvanians, including many working families and their young

adult children, in rural and urban regions of the Commonwealth

of Pennsylvania may lose their health insurance coverage and

access to affordable health care if the Congress of the United

States passes and the President signs the American Health Care

Act, thereby repealing key provisions of the Affordable Care

Act; and

WHEREAS, Repeal of two key provisions of the ACA, Medicaid

expansion and tax credit subsidies for health insurance on the

Health Care Marketplace, would result in the loss of health

insurance coverage by more than 1.1 million Pennsylvanians and

an estimated 3,525 premature deaths annually; and

WHEREAS, Reducing Federal spending on Medicaid would reverse

a 50-year trend of expanding Medicaid in order to provide health

care for the most vulnerable persons in the Commonwealth of

Pennsylvania and nationwide; and

WHEREAS, The proposed use of Medicaid block grants or a per

capita cap would likely reduce the number of Pennsylvanians

eligible for Medicaid, limit the coverage for those who remain

eligible or result in the use of enrollment caps or waiting

lists; and

WHEREAS, Hospitals in every region of the Commonwealth of

Pennsylvania would face a decline in revenue by nearly $1.6

billion, and some hospitals and medical practices, especially in

rural and urban areas, may not survive; and

WHEREAS, Repeal of the ACA would result in an estimated

137,000 lost jobs, mostly in the health care industry, an

estimated $76.5 billion reduction in the Commonwealth of

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Pennsylvania's gross State product and an estimated $24 million

reduction in State and local tax revenues over five years; and

WHEREAS, It has been estimated that by 2019, the number of

uninsured Pennsylvanians would increase from 711,000 to

1,667,000; and

WHEREAS, ACA repeal would add more than $1.4 billion to the

Commonwealth of Pennsylvania's structural deficit; and

WHEREAS, ACA repeal would have a devastating effect on

Pennsylvanians with substance use disorders and their ability to

receive addiction treatment; and

WHEREAS, ACA repeal is estimated to result in nearly $36

billion decrease in Federal funding for health care for

Pennsylvanians and $7.8 billion more in State spending over the

next decade; and

WHEREAS, ACA repeal would likely mean higher premiums,

deductibles and cost-sharing for the 57 million senior citizens

and disabled Americans nationwide enrolled in the Medicare

program; and

WHEREAS, ACA repeal would also bring back the donut hole in

Medicare's prescription drug coverage, thereby seriously

impacting older Pennsylvanians' ability to afford prescription

drugs; and

WHEREAS, According to estimates by the nonpartisan

Congressional Budget Office, ACA repeal would increase Medicare

spending by $802 billion over 10 years; and

WHEREAS, ACA repeal would likely reverse the positive

reductions in the use of hospital emergency departments for

primary care and the positive reductions in incidents of

unnecessary hospitalization achieved through the use of expanded

primary care and community resources; and

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WHEREAS, ACA repeal would likely increase the use of

emergency departments for primary care, undermining the

financial ability of hospitals while driving up the overall cost

of health care in the Commonwealth of Pennsylvania; and

WHEREAS, As introduced in the Congress to replace the ACA,

the American Health Care Act would, among other things, provide

$600 billion in tax cuts primarily to higher-income individuals

and implement an age tax that would allow insurers to charge

older Pennsylvanians five times the amount charged to young

adults; and

WHEREAS, The American Health Care Act further proposes that

income-based premium subsidies be replaced by age-based

subsidies, which would harm Pennsylvanians with moderate incomes

and make health insurance coverage unaffordable, driving many

older Pennsylvanians and vulnerable Pennsylvanians out of the

health insurance market; and

WHEREAS, Provisions of the American Health Care Act provide

for a reduction in tax credits, which would increase health

insurance premiums for many working Pennsylvanians; and

WHEREAS, Elimination of cost-sharing subsidies, repeal of the

Medicaid entitlement to coverage and elimination of enhanced

Federal funds for new enrollment in Medicaid in 2020 would

result in a massive shift of costs to the Commonwealth of

Pennsylvania, with more uninsured Pennsylvanians and fewer

Pennsylvanians receiving affordable health care; and

WHEREAS, Federal funds made available to the Commonwealth of

Pennsylvania under the ACA supplanted Commonwealth funds to

provide health care benefits to Pennsylvanians; and

WHEREAS, Given the Commonwealth of Pennsylvania's financial

situation, it would be difficult to replace the Federal funds

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lost due to the repeal of the ACA; and

WHEREAS, It has been estimated that repeal of the ACA would

increase Commonwealth expenditures by nearly $130 million,

which, coupled with the estimated reduction in tax revenue,

would add more than $1.4 billion to the Commonwealth of

Pennsylvania's structural deficit; and

WHEREAS, Major organizations and advocacy groups, including

the American Medical Association, the American Hospital

Association, America's Health Insurance Plans and the AARP, have

warned Congress that ACA repeal would leave millions without

health insurance coverage and cause potential harm to the most

vulnerable populations and unnecessary disruptions in the

coverage and care on which Medicaid beneficiaries depend; and

WHEREAS, ACA repeal without adequate mechanisms to ensure

that not one Pennsylvanian will lose coverage and that coverage

will be more affordable and of higher quality for all

Pennsylvanians would not only evidence a lack of regard for

older Pennsylvanians and millions of working Pennsylvanians and

their families who stand to lose health insurance coverage and

access to affordable health care but also for hospitals and the

insurance and health care industry as well as the economic

viability of the Commonwealth of Pennsylvania and other states

that implemented the ACA; therefore be it

RESOLVED, That the House of Representatives of the

Commonwealth of Pennsylvania respectfully urge the President and

the Congress of the United States to reject any legislation

aimed at repealing the ACA unless such legislation is crafted to

ensure the maintenance of health insurance coverage, including

coverage of the ACA's 10 Essential Health Benefits, and ensure

access to quality and affordable health care by Pennsylvanians

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who would otherwise lose their health insurance coverage and

preserve the significant gains that seniors, individuals with

mental health and substance use disorders and the underserved

rural and urban Pennsylvanians have realized through ACA

implementation; and be it further

RESOLVED, That the House of Representatives respectfully urge

the Congress to not jeopardize the health of millions of

Pennsylvanians by voting to approve ACA replacement legislation

without public review and input, including consideration of the

conclusions espoused by the Congressional Budget Office, in

order for the residents of the Commonwealth of Pennsylvania and

other states to have the opportunity to be heard; and be it

further

RESOLVED, That the Chief Clerk of the House of

Representatives transmit copies of this resolution by first

class mail, fax or electronic mail to the President and Vice

President of the United States, the Majority and Minority Leader

of the United States Senate, the Speaker and Minority Leader of

the United States House of Representatives and to each member of

the Pennsylvania Congressional Delegation.

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