Four things to know as Pennsylvania awaits key details of health care marketplace

With a week to go before a new health care marketplace launches in Pennsylvania and elsewhere, health entities and even state officials are still awaiting key details.

“We’re kind of in a wait-and-see mode,” said Pennsylvania Insurance Commissioner, Michael Consedine, who’s typically charged with overseeing and regulating insurance products in the state.

Consedine said his department has been working with federal officials on what they need to get ready, but he’s “in the audience with everyone else” when it comes to knowing specifics.

The marketplaces, previously referred to as exchanges, are a mainstay of the Affordable Care Act. Each state will have one for individuals and small-business owners to compare and shop for health plans, access income-based subsidies and find out whether they may be eligible for other health programs, including Medicaid.

Enrollment begins Oct. 1, with coverage kicking in Jan. 1.

Feds are running the Pa. marketplace

The federal government is running Pennsylvania’s marketplace.

Under the ACA, states have the option to run it themselves, to run it in partnership with the federal government, or leave it to the federal government. Pennsylvania’s decision means www.healthcare.gov is where residents will go for specifics about plans, once available, and be able to actually sign up for coverage starting Oct. 1.

New Jersey also has a federally run marketplace. Delaware, meanwhile, has a partnership one.

Key details unknown

Eight companies have submitted 15 proposals for participating in Pennsylvania’s marketplace, according to the state insurance department; a list of those companies can be found here.

“That’s a pretty good number,” said Consedine of the state insurance department, which gave preliminary approval to the proposals. “But when it comes to what ultimately [the U.S. Department of Health and Human Services] signs off on, that is up to their final discretion.”

That means the actual plans, their cost, and what provider networks will be included remain to be seen. A representative of the HHS regional office said the plans and rates will be released Oct.1.

“It’s very difficult to know how the market will adjust to everything until it happens,” said Peter L. Gualtieri, president of the Greater Philadelphia Health Underwriters Association and director of Savoy Associates.Gualtieri said that has a lot of private brokers from the region feeling behind in how they’ll assist potential new clients who may seek their help in buying plans.

“In some respects, there’s a lot of opportunity. In the short run, because we’re sort of getting ready for a game and we haven’t practiced enough and we don’t know how many yards there are on the field, that’s a little frightening,” said Gualtieri. “The individual consumers and businesses will be asking us questions on or around on Oct. 1. We’re going have to get up to be speed on what’s available and how we’ll have to interact with the government channels.”

Pa. groups involved

In states with federal marketplaces, HHS is taking the lead on marketing, outreach and consumer assistance, which includes a 1-800 number. But some area organizations will also be involved.

In Pennsylvania, five groups received federal grants to train designated navigators (Cardon Outreach, based in Florida, has since returned its funding and won’t be involved). Participants includes Resources for Human Development, which has been gearing up to reach out to upward of half a million people in Pennsylvania’s 10 counties with the highest uninsured rates.

“I think everyone’s eager to see what the [health insurance] plans look like,” said Laura Line, with Resources for Human Development. Despite the uncertainty, Line said she and others are excited about the launch. “There’s 10 weeks to enroll for Jan. 1, 2014. So we’ll have 10 weeks to get well immersed with the plans.”

The federal government has also designated certain local health agencies as hubs for trained “application counselors” to help with outreach. Public Health Management Corporation is one of them. Amanda Kimmel, a social services manager there, said everyone is eagerly awaiting final details about the insurance plans.

“It has been frustrating, especially in terms of the financial piece,” said Kimmel. “People ask me all the time, how much are these plans? It’s certainly the most common question I get. And I cannot say anything other than, I have no idea, the pricing has not been released.”

Kimmel said they’re not waiting for those details to begin outreach. She and others have been canvassing neighborhoods, spreading the word about a “town hall” Monday evening in Philadelphia, featuring health officials and outreach workers.

Expect ‘hiccups’

With the launch a week away, outreach workers and state officials are all bracing for some road bumps once Pennsylvania’s marketplace launches.

“I think there will be hiccups,” said Consedine. “We’re obviously focusing on Pennsylvania consumers and working as best we can, but it’s an evolving situation.”

Consedine says one big concern involves whether the technology will be ready and able to handle an influx of users.

“There is a tremendous amount of information that has to be exchanged between the federal government, the state government, between health insurers, between the IRS,” said Consedine. “The data platforms and systems that are needed to make sure that happens almost instantaneously, seamlessly and completely accurately are enormous. Those are the kinds of things we expect to be working through well after this is unveiled next week.”