A regional town hall meeting Monday in Altoona on the setting of next year’s Affordable Care Act exchange rates in Pennsylvania devolved into a mini-rally for national health insurance.

“Health care is a human right,” read the T-shirts of several attendees from Put People First! PA,” the group that persuaded the state Insurance Department to hold the town hall meetings in each of the state’s nine rating districts.

Transforming the existing multi-payer system to single-payer is not within the department’s power, yet the meeting provided information about the current situation that could provide ammunition for those who would advocate for such a transformation.

For 2017, the Insurance Department was forced to approve rate increases that averaged 32 percent because the federal government failed to fund a “risk corridor” subsidy for insurance companies, according to David Buono, a consumer liaison for the department.

The risk corridor subsidy, along with reinsurance — both three-year programs — and a permanent “risk adjustment” feature were all intended to help insurance companies deal with the influx of unknown and difficult subscribers the ACA was designed to insure, according to Buono.

The lack of a risk corridor subsidy, however, caused companies to drop out of the exchange in Pennsylvania, making remaining insurance companies antsy, according to Buono.

Only by providing the big increase was the department able to prevent a mass exodus of companies and the possible collapse of the market here, which would have meant that there would have been no subsidies available to the 80 percent of exchange subscribers entitled to such help, he said.

This year the market has stabilized, and companies on the exchange have asked for average increases of only 8.8 percent.

But that limited increase is at risk because the Republican Congress and the Trump administration have threatened the ACA mandate that citizens must be insured or pay a fine and have threatened the “cost-sharing reduction” subsidy that benefits the lowest-income participants in the plans.

If the individual mandate is dropped or not enforced, insurers will likely ask for a 23 percent increase in rates for next year, according to a department news release.

If the cost-sharing reduction payments — currently granted month-to-month by the administration, are scrapped, insurers will likely ask for a 20.3 percent increase, according to the news release.

If both things happen, they’d likely ask for an increase of 36.3 percent — more than the raise imposed for this year — according to the news release.

Layne Thiele, Altoona, 74, a retired railroader and veteran, who went without insurance for a while, forcing him to halve his medications, said he’s come to believe that a single-payer system is needed, given the “perverted” nature of the current setup.

“I was taught to go for the common good,” Thiele said. “We must care for one another.”