Status Report: Planning for state health exchanges

Some consumer health advocates are worried about Pennsylvania’s progress toward establishing an insurance marketplace to connect low-income people with affordable health plans, but the Corbett administration hasn’t decided that the Commonwealth will run its own health insurance exchange.

Under the Affordable Care Act, every state must have a health insurance exchange, but Pennsylvania could let the federal government set up the Web portal.

Laval Miller-Wilson leads the Pennsylvania Health Law Project. He’s hoping Pennsylvania will start laying the groundwork soon, and says it will take tremendous administrative capacity to build an easy-to-use marketplace–and prepare people to use it.

“Eyes glaze over but having the computer infrastructure to make this happen, requires investment and something that can’t be done overnight,” Miller-Wilson said.

Lots of ideological battles are ahead about how the exchange will operate. Miller-Wilson is part of a coalition convinced that insurers should compete for an opportunity to sell their plans on the Web portal.

“We want exchanges to have the authority to negotiate with those health insurers based on quality and premiums. It’s being able to limit participating health insurers based on price and quality,” he said.

New guidance from the federal government suggests that each state will be able to decide whether to take all licensed comers or pre-qualify plans and limit access to the exchange.

Pennsylvania and New Jersey each have a million-dollar planning grant from the federal government.

Insurance Department spokeswoman Melissa Fox says much of Pennsylvania’s planning was on hold until the state budget was approved. Pennsylvania has hired a consultant and planned outreach meetings for August to gather ideas from consumers and business owners.

“We’ll gather all that information and at that point we’ll be able to make a recommendation to Governor Corbett and the administration as to whether or not developing a state-based exchange is feasible or whether or not Pennsylvania should envelope into the federal exchange,” Fox said.

New Jersey is using some of its grant money to figure out what kind of information technology upgrades the state would need to build a consumer-friendly Web portal. The Garden State is also conducting research to count up the number of individuals and small businesses that might use the exchange.