President Donald Trump shakes hands with Speaker of the House Paul Ryan (R-WI) after he addressed a joint session of Congress at the U.S. Capitol.

Update, May 24: The CBO released a report estimating that under Trumpcare the number of uninsured Americans would increase by 14 million, from 28 million to a total of 42 million by next year and by 23 million to a total of 51 million by 2026. This is slightly under projections for under Trump’s first health plan. A proportional rise in Pennsylvania would mean we’d have about 1.2 million uninsured by next year, up from 800,000 now, and 1.5 million by 2026.

Under Trumpcare, about half of Philadelphians risk higher insurance prices than they’d face under Obamacare, and only about 2 percent stand to benefit from the tax cuts.

That’s one projection that can be gleaned from delving into the particulars of the American Health Care Act, which passed the U.S. House yesterday.

It’s hard to know every projection for its impact on Pennsylvania because the bill was passed before amendments to the original were vetted by the Congressional Budget Office. For the original version, the number of uninsured people in the state could’ve risen from 800,000 to about 1.2 million in 2018. For this version, we can’t say that with as much certainty.

But it is possible to project some of the particulars regarding pre-existing conditions, the tax breaks and the effects on the older population. So here’s how Trumpcare, if it ends up passing the U.S. Senate, could affect Philadelphia and Pennsylvania:

Pre-existing conditions and PA

Trumpcare still protects Americans with pre-existing conditions from being denied coverage by insurance companies. But it will roll back some of those protections. Under the AHCA, it’s likely some people with pre-existing conditions will face higher health care costs.

And in Pennsylvania, some 5.3 million could be vulnerable. That’s the number of people under age 65 in the Commonwealth who have a pre-existing condition, which could be anything from diabetes to epilepsy to many other ailments, according to a study from the Center for American Progress.

Philadelphia has an estimated 600,000 people with pre-existing conditions, basically half of the non-elderly population.

Tax cuts for 10,000

People with higher-incomes will get a tax break from this latest version of Trumpcare by not having to pay extra Medicare charges on their wage and investment income. Basically, it would eliminate a tax of 0.9 percent on wages and 3.8 percent on a piece of investment income determined by formula. The wage portion would go away in 2023 and the investment portion this year. What’s the income threshold for the tax break? Individuals making $200,000 or more per year and married couples making $250,000 or more.

In Philadelphia, about 4,600 individual households make more than $200,000, according to the Census. The Census does not include precise data for married households making $250K or more, but about 10,000 make more than $200K. So we’re talking about several thousand people who’d benefit, somewhere around 2-to 2.5 percent of Philadelphians.

Pennsylvania would have a similar percentage. Some 23,000 individual households and about 190,000 married households make more than $200K. That’s about 3 percent of Pennsylvania households.

The Medicaid threat

This latest version of the AHCA puts Medicaid on a tighter budget than under Obamacare, just as the previous iteration did. The cap could essentially shut down people who would be newly eligible for Medicaid in the coming years.

Such limits could particularly affect Philadelphia. About 18 percent of Pennsylvanians (2.3 million) are eligible for Medicaid, nearly equal to the national average, but Philly has a far greater amount. In North Philadelphia alone, 300,000 people are eligible for Medicaid, comprising 13 percent of all Pennsylvanians on the plan.

Higher rates for Trump country

Another part of the latest bill that didn’t change: likely steeper rates for older people. Under Obamacare, insurers can’t charge older people more than three times as much as they charge young people for the same coverage. Under Trumpcare, they can charge five times as much.

Philadelphia, with its relatively young population, won’t be as adversely affected by this. The more vulnerable people will be in Central and Western Pennsylvania, places like Cambria County, where 44 percent of the population is above age 55. Yep, out in Trump country.

What we don’t know

States like Pennsylvania will also have the option of letting employers withdraw certain minimum requirements for their insurance coverage that are required under Obamacare. Whether that happens in Pennsylvania won’t be clear for some time — if the bill passes the Senate.

And, of course, we also don’t know how the Senate could impact the bill. If it ends up passing, the bill is bound to undergo changes.

Questions about the AHCA’s impact locally? Send them to We’ll do more coverage as the bill moves forward.

Mark Dent is a reporter/curator at BillyPenn. He previously worked for the Pittsburgh Post-Gazette, where he covered the Jerry Sandusky scandal, Penn State football and the Penn State administration. His...