Establishing a Competitive Health Insurance Marketplace

IN FOCUS: What a Competitive Health Insurance Marketplace Can Do for Pennsylvania Families and Small Business:

  • Increase Competition Among Insurers to Ensure Quality Choices and the Best Value for Policyholders

  • Take the Headache Out of Searching for Insurance by Giving Policyholders Accurate, Unbiased Information Plans to Make Informed Choices

  • Offer Security and Stability to Pennsylvania's Health Insurance Market by Holding Insurers' Accountable to Keeping Rates Reasonable

Thanks to the Affordable Care Act, Pennsylvania is now authorized to establish a new competitive health insurance marketplace that gives working families more control, quality choices and better protections when buying health coverage.

Pennsylvania is one of many states considering the creation of an "exchange" — an easy-to-navigate marketplace that gives working people and small businesses access to the high-quality, affordable coverage options that simply don't exist today. This new marketplace will allow folks to compare health insurance plans to find one that best meets their needs, and provides new tax credits to working and middle class families to make coverage affordable.

The Affordable Care Act calls for the creation of these new insurance marketplaces, or "exchanges," by 2014. Pennsylvania can establish its own, or allow the Department of Health and Human Services to do so. 

This new marketplace will allow everyone who lacks job-based coverage or is otherwise uninsured or unhappy with the policy they have to find and secure a quality plan at an affordable rate. Small businesses can also use the marketplace to purchase affordable health coverage for their employees.

PHAN is committed to ensuring that the following key principles guide the establishment of Pennsylvania’s insurance marketplace:

  1. The marketplace should be competitive and put the needs of working families and small businesses first. The marketplace should have a governing board that includes patient voices, small businesses and insurance experts who don’t work for the industry to ensure that it makes smart decisions to improve quality and efficiency. The board should have the authority to negotiate with insurance companies to secure the best prices for folks purchasing insurance and to protect policyholders against insurer abuses, like denial of care or unjustified rate hikes.

  2. The marketplace should be accountable, transparent and easy to use. The marketplace should use clear, jargon-free language to describe insurance plans and provide well-trained “navigators” who can help individuals and families decide which coverage option is best for them. To protect against conflicts of interest, the governing board should exclude any insurance industry representatives and brokers that stand to profit from enrollment in the marketplace.

  3. The marketplace should ensure the highest quality, best value options for those purchasing insurance. The marketplace should adhere to strict quality standards and prevent insurers from raising premiums unreasonably. The marketplace will also be tasked with providing income-based tax credits to working and middle-class families. As such, it should ensure that all eligible individuals and families are protected financially by limiting co-payments, deductibles and other cost-sharing based on a family’s income. The marketplace should also leverage the buying power of the individuals participating to negotiate with insurers to offer high-value, affordable plans. 

Learn more about the choices PA lawmakers will be making in the coming months as they lay the groundwork for this new marketplace. Read our take on what this new marketplace should look like, then contact us to get involved to make sure PA gets this right!