Insurance Market Behavior

The state should ensure that a competitive insurance market exists to ensure the broadest access to comprehensive coverage, and allow hospitals and insurers to negotiate contracts without government interference. 

Advocacy

HAP Supports:

  • House Bill 533, which simplifies and streamlines the state’s physician credentialing process so new physicians and those coming from other states can more quickly begin providing health care and billing for these services.
  • House Bill 1194, which improves the prior authorization process by removing administrative barriers that delay patient access to care and services, burden providers, and result in hospital underpayments.
  • Act 42 of 2019, which allows the Pennsylvania Insurance Department to create a state-based health insurance exchange by 2021. A state exchange will produce savings for state insurers who are now charged for operating the federal exchange. The  savings will in part be used to create a reinsurance program with the  goal of lowering premiums for health insurance options. A new authority will create, manage, and maintain Pennsylvania’s state-based health insurance marketplace

At the federal level, HAP has endorsed legislation—H.R. 3107, the Improving Seniors’ Timely Access to Care Act—introduced by U.S. Representative Mike Kelly’s (R, PA-16) in partnership with Representatives Suzan DelBene (D-WA), Roger Marshall, MD (R-KS), and Ami Bera, MD (D-CA), that would help protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program.

 

HAP Opposes:

Short-term Limited Duration Insurance

During 2018, the federal government expanded the availability of short-term, limited duration health plans. These plans were designed to serve as a temporary alternative for a consumer with a gap in insurance coverage. These plans do not have to meet the minimum requirements for comprehensive coverage under the Affordable Care Act. They can exclude preexisting conditions and deny coverage due to a preexisting condition. The plans do not have to cover essential health benefits, prescription drugs, preventive services or substance use disorder treatment.

Any Willing Insurer Proposals

HAP opposes Any Willing Insurer proposals, which would force hospitals to contract with any interested insurer. This approach forces a one-size-fits-all system for how hospitals must contract with insurers and how they are paid for patient care. Any Willing Insurer would hinder contracts that promote innovative care models and hospitals' ability to address specific patient and community health care needs. HAP advocates for elective network contracting, which is a fundamental to the competitive process and the concept of managed care––adopted by the state and federal governments to control costs and improve care. 
   

HAP Contacts

For more information, contact Jeffrey Bechtel, senior vice president, health economics and policyJolene Calla, vice president, health care finance & insurance; or Kate Slatt, vice president, innovative payment and care delivery. For media inquiries, contact Rachel Moore, director, media relations.

HAP News

June 29, 2020

U.S. House Passes Measure to Stabilize ACA Marketplace

The U.S. House of Representatives today passed legislation to bolster critical portions of the Affordable Care Act (ACA). The measure’s momentum comes on the heels of recent action by the Trump Administration aimed at dismantling the ACA.

May 21, 2020

The ACA Will Cover More People as a Result of Job Losses Due to COVID-19

The Kaiser Family Foundation estimates that 26.8 million people across the country will become uninsured due to the loss of job-based health coverage. While many of those people qualify for full coverage under the Affordable Care Act, estimates suggest that 5.7 million people will not be eligible and will have to pay the full cost for health coverage.

+