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Testimony: State-Based Exchange, Insurance Committee

Statement of The Hospital and Healthsystem Association of Pennsylvania For the

Insurance Committee, Pennsylvania House of Representatives Submitted by

Stephanie Watkins
Vice President, State Legislative Advocacy

Harrisburg, Pennsylvania May 7, 2019

My name is Stephanie Watkins and I am the vice president for state legislative advocacy for The Hospital and Healthsystem Association of Pennsylvania, or HAP. The Hospital and Healthsystem Association of Pennsylvania (HAP) advocates for approximately 240 member organizations across the commonwealth, as well as for the patients and communities they serve.

HAP appreciates the opportunity to provide comments to the House Insurance Committee about how a state-based exchange and reinsurance program could benefit the residents of Pennsylvania. During my brief comments today, I will first address HAP’s position on the Affordable Care Act (ACA) to provide context to the testimony, and then offer some thoughts regarding the Insurance Department’s proposal to create a state-based health insurance exchange.

Health Care Reform

Pennsylvania hospitals have consistently supported efforts to ensure coverage for all individuals. The framework established under the ACA—which offers subsidized coverage through health care insurance exchanges reflecting the market in each state, combined with expanded access to Medicaid—is the most viable mechanism to expand coverage and reduce costs.

Unlike what’s happening in other states, in Pennsylvania the individual and small group health insurance plans under the ACA remain stable. For 2019, in aggregate, individual plans will show a 2.3 percent rate decrease statewide and an average 2.6 percent increase for small group market plans. Additionally, all but ten of Pennsylvania’s counties have more than one insurer offering coverage and additional insurers are joining the individual market during 2019 in 30 Pennsylvania counties.

Despite these successes, there have been challenges to the law from various points on the ideological spectrum. In light of the uncertain political environment, HAP has embraced a multi- faceted strategy to advocate for affordable, comprehensive coverage for as many Pennsylvanians as possible, and for protection of access to care for all Pennsylvanians.

Efforts include:

  • Promoting insurance enrollment—In an effort to coordinate and maximize open enrollment outreach efforts and reach more individuals, HAP has actively partnered with the Pennsylvania Insurance Department and other stakeholder groups to convene hospitals, community health centers, health care providers, navigators, consumer advocates, insurance companies, and state officials to implement education and outreach strategies that match individuals with appropriate health care coverage
  • Maintaining coverage gains achieved through the ACA—HAP continues to work with the Pennsylvania Congressional delegation and federal policymakers to protect comprehensive health coverage, including expanded Medicaid coverage, and oppose Administrative policies that weaken coverage within the health insurance marketplace
  • Supporting state efforts to protect and promote coverage—Governor Tom Wolf, Insurance Commissioner Jessica Altman, and Secretary of Human Services Teresa Miller have reiterated their priority for Pennsylvania to enforce consumer protections provided through the ACA, and continue to nurture a viable and stable insurance market

HAP will continue to partner with federal and state officials, and health care stakeholders, in support of all efforts to maintain and expand access to meaningful coverage and high-quality care in Pennsylvania.

State-Based Exchange and Reinsurance Program

The Pennsylvania Insurance Department is proposing to create a state-based health insurance exchange to better serve Pennsylvanians with a target implementation date of 2021.

After the ACA passed during 2010, the administration of then-Governor Tom Corbett began an analysis of the implications for Pennsylvania. As you may recall, the Corbett administration was still seeking clarity around implementing a state-run exchange days before the federal deadline. By 2012, it determined that the federal exchange was the best option for the state, and Pennsylvania joined 28 other states that adopted the federally run exchange.

While HAP understood these challenges and the decision at the time, the association has consistently supported efforts to evaluate the possibility of a state-based exchange that could better meet the needs of Pennsylvania

Consequently, HAP is pleased that the Insurance Department now is investigating and pursuing this opportunity. We also understand that legislation is necessary to authorize Pennsylvania to transition to a state-based exchange, and we are now reviewing draft language and will provide specific input.

Generally speaking, a state-based exchange could provide:

  • Greater control of all aspects of the enrollment and reenrollment processes
  • Increased flexibility to manage the operational aspects of the marketplace based on Pennsylvania consumer needs
  • Increased access to data
  • Greater visibility to do targeted outreach and education efforts
  • Potential savings

Perhaps most importantly, research has shown that states with state-based marketplaces have been more successful at containing premium growth and maintaining enrollment. This is due, in part, to the enhanced ability of states with their own marketplaces to improve outreach and enrollment and to support policies—such as reinsurance—intended to improve individual market risk.]

In short, if a state-based exchange will improve marketplace enrollment and contain cost growth—while, at the same time, promote adequate hospital reimbursement rates necessary to maintain access to care—HAP will be supportive.

It has been a long-standing priority of HAP to help as many people as possible get and keep health insurance coverage, and we are committed to working with this committee, the administration, and the General Assembly to support this effort.



Topics: Health Care Reform, Insurance

Revision Date: 5/7/2019

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