The Pennsylvania Insurance Department is currently seeking the public’s input on what Pennsylvania’s new health insurance marketplace should look like. This new marketplace (an “exchange”) will allow everyone without job-based coverage (including small businesses, folks that are self-employed and folks whose at-work premiums cost more than 9.5% of their income) to find and secure high-quality coverage at an affordable rate. Tax credits will be available to everyone with incomes under 400% of the Federal Poverty Level–that’s up to $90,000 for a family of four in 2014 dollars.
Pennsylvania can choose to establish a state-based marketplace, or elect to let the Department of Health and Human Services set one up for us. Most everyone agrees that it’s best for Pennsylvania to operate it’s own exchange–and to do so, it must start the planning process now in order to have this new marketplace ready and open for business by Jan. 1, 2014.
If we decide to operate a Pennsylvania-based exchange, our General Assembly will need to pass legislation creating it. That is partly why our Insurance Department is holding these hearings now–to generate feedback from the public and use that input to make recommendations to our state legislators on what this new marketplace should look like.
The creation of this new marketplace is one of the most critical pieces of the Affordable Care Act. Right now, folks that don’t have job-based insurance (and the purchasing power that large companies enjoy) it is near impossible to find affordable, quality coverage. Creating this new marketplace will finally give Pennsylvania families and small businesses the high-quality, affordable coverage choices that simply don’t exist today.
That’s why it’s so important that this new competitive marketplace take steps to ensure that working families and small businesses have the best, most affordable options, and benefit from a strong, transparent, well-functioning marketplace.
There are a few key things Pennsylvania can do to make sure this happens–and PHAN, along with our coalition partners–spoke out in favor of these guiding principles at the Insurance Department hearings:
- Give the exchange the power to negotiate. This makes sure that folks purchasing insurance have the best quality, best value plans to choose from. Insurance companies stand to gain between 800,000 and 1.2 million new customers in Pennsylvania through this new marketplace. As such, they need to compete for the opportunity to be included, which they can do by offering comprehensive, quality plans that are affordable. If we let anyone set up shop and sell any inadequate/unaffordable plan, we’ll end up with a marketplace that’s no different than the one we have right now–one where insurers dictate our choices, where costs continue to rise, and where we’re left to choose between going without or breaking the bank.
- Make finding and purchasing coverage easy. It is extremely difficult in today’s market to find, compare and select insurance. Insurers don’t always disclose the specifics of what’s covered and what isn’t (or you find that changes when you try to use the insurance!), you can’t make side-by-side comparisons, and it’s often hard to get a straight answer, making it impossible for folks to get the information they need to make an informed decision. Pennsylvania can simplify this process by allowing independent “navigators” to provide folks with accurate, unbiased information on plans; requiring insurers to describe their plans in a standard, easy to understand way; closely coordinating with PA’s Medicaid and CHIP program to ensure folks maintain their coverage as situations change; and establish assistance programs for folks to turn to if they have questions or problems with their plan.
- Work for and be accountable to the people of Pennsylvania, not an insurance company’s bottom line. We know what happens when our health care system is allowed to put the needs of big insurance giants above those of working families–people are shut out, priced out, forced to live with inadequate or no coverage, forced to gamble with their health and exhaust their savings to pay for care. We cannot allow this new marketplace to operate for private gain at the expense of the public interest. That’s why Pennsylvania should take steps to ensure that the governing board is made up of patients and insurance experts who don’t work for the industry; that there are strong conflict of interest protections to ensure that no one with direct financial ties to the health industry gains undue influence in how the exchange operates; and that the governing board be accountable and accessible by regularly holding public meetings to get feedback on its activities and policies.
If we’re going to make the promise of the Affordable Care Act real to the 1.2 million Pennsylvanians who are currently uninsured–we have to get this right. And we can do that by getting in all of our legislators’ ears before they return to Harrisburg on Sept. 26th with the message that a competitive, transparent marketplace is good for policyholders, good for businesses and good for Pennsylvania.
It’s in their hands now–but those hands are elected by us, and we need to let them know how important it is to get this right!
Here’s what you can do:
- Help us get more co-sponsors on our “Priorities for Pennsylvania”–a set of principles that we believe should guide the creation of this new marketplace in Pennsylvania. Download a copy of the principles here, and share them with any organization you belong to (be it a church, advocacy group, law firm, retiree or professional association, social club, etc). We need everyone to stand with us to win a strong, people-friendly exchange.
- Send in your comments to the Pennsylvania Insurance Department. Read our summary of what a strong PA exchange should look like, share your concerns and ideas with the Department. Remember, they will be summarizing the public’s feedback and using it to shape their recommendations to our legislators. Now is our time to be heard! You can email your comments to RA-IN-PAHealthOptions@state.pa.us (in PDF or Word format) or mail them to: Pennsylvania Insurance Department, 1326 Strawberry Square, Harrisburg, PA 17120.
- Talk to your State Senator and Representative! They’re the folks who’ll be responsible for enacting legislation creating this new marketplace, and they need to know we’re all watching what they’re doing! This marketplace could be a great thing for Pennsylvania families, but it’s up to them to get it right. Contact the PHAN staffer in your area for help getting or preparing for a meeting in person or on the phone. Find your legislator here.
- Educate yourself and your community! Join our next policy call, on Tuesday, August 23rd at 6pm–we’ll be talking all about this new marketplace and the key decisions Pennsylvania needs to make in the upcoming months to stay on track with implementation. Click here to RSVP!
- Help us organize a forum in your community where we can talk with advocates and the public about the great opportunity Pennsylvania has to create a marketplace that truly works for all of our families. Contact the organizer in your area to plan an event this fall!
Learn more about the benefits a strong, people-driven marketplace in Pennsylvania and what PHAN is doing to make it happen!