Repealing the Affordable Care Act would cause significant financial pain to businesses, patients, and taxpayers in Pennsylvania, according to a report released Thursday. The state's projected budget deficit would nearly double, and an estimated 3,425 additional residents would die prematurely each year.

The nonpartisan Congressional Budget Office had projected two days earlier that partial repeal would increase the ranks of the uninsured nationwide by 18 million the first year and 32 million within a decade.

In the new state analysis, the Pennsylvania Budget and Policy Center estimates that 1.1 million state residents would lose coverage within a few years, and that the rate of uninsured children would double. But the report goes beyond loss of insurance  to detail the secondary and broader impacts of reduced spending.

Among its findings:

  • More than 137,000 Pennsylvanians would lose their jobs. About 42 percent would come from health care, but retail as well as construction and real estate would take significant hits.
  • Revenue for hospitals and other care providers would decline substantially. "Some hospitals and physician practices, especially in urban centers and rural areas, may not survive," the report says.
  • The state's budget deficit, already estimated at $1.7 billion next year, would rise by an additional $1.4 billion.

The report by the left-leaning research and policy center in Harrisburg did not address New Jersey. But a November analysis from New Jersey Policy Perspective predicted dire effects there, with 32 percent of adults in Camden at risk of losing coverage, the highest percentage in the state. It, too, projected major consequences for hospitals and the state treasury.

Both reports examined the impact of repealing key sections of the ACA along the lines Republicans in Congress have repeatedly approved but President Obama has vetoed. Congressional leaders have said they want to keep the most popular parts of Obamacare but have not agreed on a replacement plan.

President-elect Donald Trump has said he expects to propose a plan under which no one would lose coverage. a statement his transition team has walked back somewhat.

Marc Stier, director of the Pennsylvania Budget and Policy Center and the author of the new report, said insurance is costly because advances in medical care are costly, so that health care amounts to 18 percent of the U.S. economy.

"Make no mistake, almost no one has health insurance without government support in America," he wrote in the report. "The half of Americans who receive health insurance through their employer often fail to realize that they receive a huge tax break for the cost of that insurance because it is not counted as income. Indeed, the cost of that tax break every year, $250 billion, is twice the cost of the ACA itself."

Other sections of the report explained why repealing the Affordable Care Act would cost Pennsylvania more.

The ACA pays for several health programs that used to be funded by the state but remain on the books and would again be supported by Pennsylvania taxpayers. The state's Pharmaceutical Assistance Contract for the Elderly (PACE) program, for example, helped low-income seniors afford medications.

The ACA saved saved PACE and the related PACENET programs $70 million a year. That money, from the state lottery, now goes into the general fund.

The report's estimate of 3,425 additional premature deaths as the result of lost coverage is based on previously published research.

About 685,000 low-income Pennsylvanians gained coverage through the ACA's Medicaid expansion. Stier projected that 100,000 of them would be able to get employer-based coverage.

Another 412,000 with low to moderate incomes received coverage last year through the ACA marketplace, or exchanges. Nearly 80 percent got hefty subsidies to make it affordable, and most would become uninsured if those tax credits  stopped.

The impact of repeal also would affect those not eligible for subsidies, as well as people who buy individual coverage directly from insurers or through private brokers.

"We expect that the non-group health insurance market will largely collapse in Pennsylvania," the report says.