More expected to forgo health coverage

including Highmark, also have encountered members in ACA plans who were sicker and therefore costlier to treat than anticipated, driving up costs.

The end of the individual mandate penalty is expected to increase the number of uninsured in Pennsylvania by 500,000,as consumers drop out of both ACA and individual health plans, said Antoinette Kraus,director of the PennsylvaniaHealth Access Network, a Philadelphia-based educationand advocacy group.

Ripple effects could include an increase in hospital bad debt, as consumers without health care coverage seek care in the emergency room, she said.

Deborah Rice-Johnson, presidentof Pittsburgh-based Highmark Inc., agreed, saying, “I still worry about the provider systems” and the “significant impact of potential bad debt.”

The mandate repeal is likely to drive more carriers out of the market, leaving consumers with fewer choices in the future, said Sabrina Corlette, senior research professor, Georgetown University Center on Health Insurance Reforms.

In the Pittsburgh region, both Highmark and UPMC Health Plan have said they plan to stay in the ACA marketplace.

While Highmark has throttled back its presence in the Affordable Care Act market, UPMC Health Plan has expanded and now controls about 84 percent of the Western Pennsylvania market, Mr. Scott said.

UPMC Health Plan, the insurance arm of the Downtown-based hospital network, has flourished by targeting consumers who are eligible for premium subsidies, Ms. Corlette said, a segment of the market that seems “fairly stable.”

“They’ve really gone after the market for the subsidyeligible,” she said.

Tax credits increase dollar for dollar as premiums rise, so consumers who are eligible for subsidies have been insulated from higher premium costs this year, Ms. Corlette said.

Not so for people whose income disqualifies them from tax credits. They’re likely to see big premium increases starting in 2019.

“This is the way they can really chip away at the Affordable Care Act,” Mr. Scott said about the penalty repeal. “The premiums are going to jump and these people are going to have sticker shock like they’renever seen before.”