Pennsylvania Moving Forward on Insurance Marketplace; Industry Working to Influence Lawmakers to Do the "Bare Minimum"

In an email today, the Pennsylvania Insurance Department announced it’s intent to move forward on establishing a health insurance marketplace in PA. The Department has applied for funding from the US Department of Health and Human Services (HHS) to complete the planning and begin designing a new health insurance marketplace (an “exchange”) that needs to be open for business on January 1, 2014. 

This new marketplace will be where everyone who is currently uninsured--whether they’re laid off, working for an employer who doesn’t offer coverage, self-employed or a small business, will be able to shop for and secure affordable, quality coverage that meets their needs and budget. (Learn more about the new protections, coverage options and benefits of this marketplace here). 

Because the Affordable Care Act valued the needs of individual states, the law laid out a broad sketch of what this new marketplace could look like but gave individual states the power to determine all the particulars--from  what kinds of plans are offered, to whether or not the exchange negotiates with insurers to get the best value and choices for families and small business, to where and how it operates. 

These are important questions that the Pennsylvania Insurance Department will make recommendations on to state lawmakers within the coming weeks, as they draft legislation to create this new marketplace. Already, the insurance industry has positioned itself to drive this process--pressuring lawmakers and doing whatever they can to write the rules and tilt what should be a level playing field in their favor. 

Here’s what we need to keep in mind as this fight heats up in Harrisburg:

The marketplace needs to serve working families and small business, not an insurance company’s bottom line. Think about why we needed a new marketplace in the first place... our current one is fundamentally broken! Working people and small businesses lack the buying power to negotiate for better rates and fair treatment, leaving insurance companies free to deny folks coverage, charge women more than men, and jack up rates excessively and without justification. This forced too many families and small businesses to drop coverage because of the skyrocketing costs. In this new marketplace, our legislators should not give insurance companies a free pass to keep treating us all like (use your imagination!). They need to make the responsible choices necessary to end these discriminatory and unethical practices by: 

• Leveraging the buying power of folks purchasing coverage in the new marketplace to negotiate with insurers to make sure working families and small businesses have high-quality, high-value choices. Rather than letting insurance companies dictate the costs and quality of coverage, lawmakers should ensure they compete for the opportunity to secure our business based on price and value. 
• Laying down some rules of the road to keep insurance companies honest--and keep you and your family protected. Insurance companies should not be able to cancel your policy, raise rates or cut benefits without justification (and an opportunity for you to appeal), and they should provide you, the policyholder, with accurate and easy to understand information about what their plan covers and how much common medical events (like pregnancy or diabetic care) will cost you. 

Insurance companies are good at spin, and they’re good at getting what they want. What they want, in this new marketplace, is to retain the power to charge you as much as they can with no accountability, offer low-benefit plans or find ways to not cover the benefits you’ve been paying premiums for, and to use nice-sounding words like “choice” and “flexibility” to avoid abiding by the new patient protections the Affordable Care Act puts in place. Be on guard, and when you hear the industry or state lawmakers talk about things like “choice, flexibility, and a free market approach,” remember what that means: 

• “Choice” = Code for letting insurance companies do all the choosing--how much your health is worth, if you can have the treatment your doctor prescribed, if you can afford to keep quality coverage and whether or not you have any peace of mind when it comes to your health.
• “Flexibility” = Code for allowing insurance companies to find and exploit loopholes to get around giving you the coverage, security and fair treatment you deserve. 
• “Free Market Approach” = Code for giving insurance companies a free pass to tilt the playing field in their favor, escape any meaningful accountability for how they’re treating you, the policyholder, and game the system to continue cutting corners, cutting coverage, raising rates and jeopardizing the security and health of you, your family, and/or your small business. 

Pennsylvania lawmakers are accountable to you, your family and your community--not some insurance industry executive doling out campaign cash. Insurance companies invested millions of dollars into their campaign to defeat the Affordable Care Act. Now that the law has passed and folks are already feeling the benefits, they’ve changed shifted their focus, and are now actively working to weaken as much of the law as they can at the state level. In Pennsylvania, with a Governor who sued to repeal the Affordable Care Act, and majorities in both the House and the Senate who oppose holding insurance companies accountable (remember adultBasic?), they have a real opportunity to do this. That’s the bad news. The good news is that, at the end of the day, our legislators are accountable to us and our votes, not the insurance industry’s campaign contributions. 

What’s next? 

Legislation will be introduced soon, and PA lawmakers have a great opportunity to stand up for working families and small business by establishing a marketplace that is transparent, accountable, easy-to-use and ensure folks purchasing insurance quality coverage they can afford. Our message now is: don’t squander it. Do the right thing. Do more than the bare minimum. (Download and share this fact sheet laying out what working families need vs. what insurance companies want so you'll know whose side your representatives are on!). 

Help us take that message to every member of the state legislature--especially those on key committees, like the House Health and Insurance Committees, and the Senate Insurance Committee. If you’re in the West, email Erin to set up a meeting with your representatives. If you’re in Central PA or the East, email Athena. 

Write a letter to the editor. Share information with your friends, family, neighbors and coworkers. Let’s raise our voice and make sure Pennsylvania gets this right!