Pa. will run its own health insurance exchange

Taunya English’s story is part of a project on health in the states, a partnership between WHYY, NPR and Kaiser Health News.

Taking the reins, Pennsylvania will establish a health insurance exchange to comply with the federal Affordable Care Act.

The health law requires that each state have a marketplace where individuals can shop for health coverage. If states don’t set up the exchange, the federal government will do it for them.

As attorney general, Gov. Tom Corbett added Pennsylvania to those states suing to block the Affordable Care Act. Still, it seems he listened when insurance companies, brokers and consumer advocates said it’s time to move ahead and start implementing key provisions of the law.

State insurance department spokeswoman Rosanne Placey said Corbett continues to have deep concerns about the law, but it’s important that the state maintain authority over insurance decisions.

Alan Weil, who leads the National Academy for State Health Policy, said there’s a contingent in every state that thinks the most appropriate response to the law is to do nothing.

States stepping up to control exchanges

Weil said he hasn’t seen much political backlash for governors who oppose the Affordable Care Act and decide it’s in their state’s best interest to pursue federal grant money, and start carrying out the law’s requirements.

“I think the majority view, in most states is, with the law on the books, at the end of the day we’d rather have our fate in our own hands, and we may hold our nose a little bit as we are taking some of the steps, at least we can make the decision that work best for our state,” Weil said.

The state already runs the Medicaid plan, and Weil says also opting for a state-run health exchange may provide better coverage continuity for low-income people who move from one system to the other.

Decisions about where to house the marketplace, which companies can participate and what benefits and prices will be allowed are all ahead.

“The starting gun went off several months ago, and Pennsylvania doesn’t want to get behind other states,” said Laval Miller-Wilson, who leads the Pennsylvania Health Law Project and is part of the Pennsylvania Health Access Network. “What’s at stake is tens of millions of dollars that Pennsylvania would have forfeited to establish the exchange.”

Miller-Wilson says a U.S.-run exchange would likely be a one-size-fits-all approach, but a state-run marketplace means more flexibility to set rules and vet the companies that will sell health coverage.

One big decision that’s still ahead: Should an existing agency, such as the Department of Health, oversee the exchange, or should Pennsylvania establish a separate quasi-governmental organization to make day-to-day decisions?