What it is: On July 2, 2019, Governor Tom Wolf signed House Bill 3 into law. The legislation does two key things for those in the individual health insurance market:
- Establishes an online state-based exchange program
- Creates a reinsurance program to cover some high-cost claims
Since the Affordable Care Act was first implemented, Pennsylvania has used the federal platform (HealthCare.gov) to enroll citizens in health insurance plans. Now, Pennsylvania is joining about a dozen other states that operate their own exchanges and leverage “lessons learned” to plan for and coordinate a responsibly staged implementation. There are several benefits to having a state-based exchange; UPMC and UPMC Health Plan supported this transition because of the positive impact it will have on consumers.
The state-based exchange is expected to be up and running in 2021.
Why it matters: Over the past five years, Centers for Medicare & Medicaid Services has made several “one size fits all” adjustments to HealthCare.gov including shifts in enrollment periods, a decrease in marketing, and the reduction of enrollment support resources. Coupled with the limited flexibility that comes from having one platform serve dozens of states, enrollment has become more challenging for working families and financially vulnerable individuals.
By operating its own exchange, Pennsylvania can ensure that open enrollment periods are accessible and consistent and that consumers clearly understand their insurance options and the timeframes within which decisions must be made.
In addition, Pennsylvania will have greater control over funding, structure, and management, allowing the state to ensure that the needs of citizens are met. Among other things, the approach will maximize the chance that savings resulting from administrative efficiencies are tied into and benefit the communities.
Related: Health Insurance Glossary: A Guide to Terminology
Where UPMC stands: At UPMC and UPMC Health Plan, we believe Pennsylvania is well positioned to take the lead in shaping the future of the state’s exchange and ensure that all Pennsylvanians continue to have affordable access to high-quality, innovative coverage and care.
With almost 140,000 individual members, UPMC Health Plan is one of the largest carriers on the exchange and remains committed to being part of the individual marketplace in Pennsylvania. While we are thankful that the federal platform has been available to date, we believe a state-based exchange could accomplish the following:
- Improve operational flexibility
- Deliver a more consistent and uniform consumer experience
- Ensure that savings be directed to the benefit of communities
In addition, the reinsurance program is equally promising because it could help defray the costs of providing medical care for individuals who suffer from the most serious illnesses or injuries. What this means is that individual market premiums for all consumers will ultimately be reduced and access to care for those who rely on the exchange for coverage will be increased.