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Health care and the election: Answering your questions

We field questions about health care from our readers who responded to this week's election text alerts.


This week, we talked about how health care became one of hottest topics during this mid-term election cycle. Our readers asked great questions in response to our daily election text alerts. Here are some of those questions and the answers.

What portion of Pennsylvania residents are covered by ACA marketplace plans, as opposed to employer-sponsored health plans?

Though it gets a lot of attention, the Affordable Care Act marketplace sells insurance plans to a very small portion of Pennsylvania residents. Individual health plans, including those sold through the ACA marketplace, are bought by people who don't have access  to good insurance through an employer and aren't eligible for Medicare or Medicaid. Just 5 percent of Pennsylvania residents have an individual health plan. Employer-sponsored health plans are by far the most common kind of insurance, covering 46 percent of Pennsylvania residents. Medicare (for seniors and some people with disabilities) covers 20 percent of residents. And Medicaid (for low-income individuals, families and children) covers 23 percent of residents. The state has a record-low uninsured rate of just 5.6 percent.

How many people in Pennsylvania opted out of insurance after the removal of the tax penalty?

The ACA's individual mandate required most people to buy health insurance or pay a tax penalty. At the end of 2017, Republicans passed tax legislation that reduced the penalty for not buying insurance to $0 — but that doesn't take effect until January 2019.

Economists and policy analysts expect that without a tax penalty, people who are healthier may drop their coverage or move to less expensive, less comprehensive plans that the Trump administration made more accessible this year. Short-term limited duration health plans have cheaper premiums because they are not required to cover things like prescription medications and pre-existing conditions. Trump eliminated an ACA rule that barred these plans from being used as year-round health insurance.

>> VOTERS GUIDE: View candidates in the 2018 midterm election based on your address, or browse all the action in Pennsylvania, New Jersey, and Delaware

Anyway, if you didn't buy health insurance in 2018, expect to pay a penalty when you file taxes next spring. Penalties vary depending on how long you were uninsured, your income level and the number of people in your family who were not covered. An individual who went the whole year without insurance will pay $695 plus inflation or 2.5 percent of their income, whichever is higher.

Is there anyone in PA promoting a state scheme [individual mandate] similar to the one NJ enacted?

Not that we're aware of. A state-level individual mandate would require legislation and there are no active bills being considered in Pennsylvania's House or Senate to that end. The session is nearly over, so any new bills seeking to create an insurance mandate would likely have to wait until January, when the next session starts.

New Jersey, Massachusetts, Vermont and Washington, D.C., have replaced the zeroed-out federal penalty with their own to avoid an increase in the uninsured rate and a spike in premium rates that could result from young, healthy people dropping coverage and leaving only sicker, more expensive people in ACA marketplace plans. New Jersey, for example, said it was able to approve an average premium rate decrease of 9.3 percent for individual health plans in 2019 — as opposed to the 5.8 percent rate increase insurers sought — because of its individual mandate and a reinsurance program that will help insurance companies pay for their most expensive members.

How can voters identify the groups paying for campaign ads and whether they have an anti-ACA agenda?

Every political ad must disclose who paid for it. This detail comes at the very end of the ad and, like the potential side-effects rattled off at the end of a drug commercial, can move quickly, so have your pen and notepad ready. Take to the internet to read up on the groups and their positions on the Affordable Care Act. You can also look up organizations on the Federal Election Commission's website ( to see a list of any campaign contributions that group has made to political candidates and parties, which will give you an indication of where they fall on key issues.