About 1.1 million Pennsylvanians — one in 10 under the age of 65 — are insured under the Affordable Care Act, according to state data.

As of February, more than 426,000 Pennsylvanians had signed up for individual plans, with more than 75 percent of them receiving financial assistance to offset premiums. An additional 700,000 in the state receive health care through the Medicaid expansion that was implemented by Gov. Wolf in 2015. The rate of uninsured fell to 5.6 percent in 2016, the lowest on record.

New Jersey's total enrollment is 244,000, and about 52 percent of those are eligible for the subsidy assistance.

What just happened?

After Republicans failed to enact a key Trump campaign promise abolishing the Affordable Care Act, President Trump on Thursday delivered a gut punch to the law, announcing the administration would stop $7 billion in subsidized payments to insurers that enable lower-income Americans to afford coverage. Currently, about nine million Americans rely on Obamacare for coverage.

What does this mean?

The individual insurance market could quickly implode. Without the subsidies, premiums might soar or insurers would withdraw en masse, leaving more people without insurance.

When will this happen?

The Obama and Trump administrations had been making the subsidy payments month by month, so two Trump administration officials said Friday that payments would cease immediately. The next payment is due next week.

At the same time, Pennsylvania Attorney General Josh Shapiro announced he is joining 18 other attorneys general to sue the president and force him to make the next payment.

"Our lawsuit alleges that by stopping these payments unilaterally, President Trump has acted arbitrarily and capriciously and in clear violation of his legal responsibilities under the Affordable Care Act. And through his ongoing efforts to sabotage the ACA, he has failed in his constitutional obligation to take care that the laws be faithfully executed," Shapiro stated. "President Trump swore an oath to uphold our laws. Under the Affordable Care Act, the administration must make these payments, no matter the president's personal views."

What else is coming?

Trump laid the groundwork for easing the requirement that those opting out of insurance must pay a penalty. He would weaken the directive that policies have to provide a minimum set of benefits regardless of the patient's health, leading to cheaper policies that could be offered by associations of small employers and wouldn't cover pre-existing conditions or maternity care. Another possible consequence could include measures to curb consolidation of hospitals, doctors and insurers, which could drive up prices.

Most of these changes need public comment and agency reviews, so it could take months for new regulations to be adopted. The coverage next year could be unaffected, but major changes could be coming in 2019.

What Trump tweeted:
What Republicans are saying

Sen. Lindsey Graham (R., S.C.) said in a statement on Thursday he supported Trump's executive order, in part because it accomplishes some of what he aimed to do with his own health-care proposal, which failed to advance to a vote in the Senate in late September.

"This decision, combined with creating more consumer choices for health-care policies, will improve quality and lower costs," Graham said, according to the Charleston Post and Courier.

Republican House Leader Paul Ryan voiced his approval for the plan in a statement tweeted out by Sahil Kapur, national political reporter for Bloomberg News.

"Obamacare has proven itself to be a fatally flawed law, and the House will continue to work with Trump administration to provide the American people with a better system," Ryan stated.

Democrats took to social media to voice their concerns.
Reaction has been swift from those in the health care industry:

Daniel J. Hilferty, president and CEO of Independence Health Group: "We want to assure our members that their coverage remains in effect and unchanged. We are currently evaluating what this announcement may mean for individual consumer plans in the future."

Antoinette Kraus, Executive Director of the Pennsylvania Health Access Network: "The reckless and short-sighted decision by the administration to end cost-sharing subsidies for 233,663 Pennsylvanians — 55 percent of all marketplace enrollees — will leave hardworking people facing higher premiums and a chaotic insurance market. In many states, rates are certain to increase and some insurers may leave the market. In Pennsylvania, however, proactive planning on the part of the state's Insurance Department means that no insurers will leave the market, although rates are likely to increase by a bare minimum of 20 percent."

Andy Carter, president and CEO of the Hospital and Healthsystem Association of Pennsylvania: "Pennsylvania's hospital community is deeply disappointed by the president's executive action to end the federal cost-sharing subsidies that help lower-income individuals secure health-care coverage. Under the Affordable Care Act, Pennsylvania has made great strides to lower the state's uninsured population and improve the overall health of its residents. While we are concerned by this action, Pennsylvania's hospital community remains committed to working with policymakers to safeguard access to high-quality health care coverage. We implore Congress to take swift, bipartisan action to protect consumers from these steep premium increases and help support a robust and competitive insurance market."

Betsy Ryan, New Jersey Hospital Association,President and CEO: "We call on Congress to step in and swiftly complete work on a repair plan, including reauthorizing the Children's Health Insurance Program. That critical program to protect our kids expired Sept. 30 with no action by our elected officials. This is a very troubling time for U.S. families."

When is open enrollment?

The executive orders come three weeks before open enrollment for subsidized private insurance on Healthcare.gov begins on Nov. 1, and is set to run through Dec. 15.