Pennsylvania has moved more slowly than some states but is making progress toward a health insurance exchange ? even with a governor who opposes the federal health care law.
Pennsylvania and most other states applied for and received a $1 million grant toward the early costs of creating an exchange, which is required by the law championed by President Barack Obama and approved by Congress in 2010.
The purpose of the exchange is to provide an online store where individuals and small businesses can compare and buy health insurance. Other goals include making health insurance easier to understand and creating more competition among insurers.
All states must create an exchange or the federal government will do it for them.
Pennsylvania used the initial grant to hire a consultant to carry out tasks such as surveying businesses and the public on what they want from an exchange.
Now people in the state Department of Insurance are finishing up the application for a second grant to fund more work toward creating the exchange.
About 30 states have applied for such grants and received amounts ranging from $1.6 million in Tennessee to nearly $40 million in California.
?Pennsylvania has taken steps towards the establishment of an exchange, which I think is positive. ... There are other states who have moved more aggressively, including states whose governors are part of the lawsuit,? said Sharon Ward, director of the Pennsylvania Budget and Policy Center, a nongovernment organization that supports the federal health care law.
Ward was referring to the lawsuit challenging the health care law largely on the argument that it is unconstitutional to require people to buy health insurance.
Gov. Tom Corbett, who joined the lawsuit when he was attorney general, is among leaders from 26 states pursuing the lawsuit. The U.S. Supreme Court plans to hear arguments in March.
State Rep. Anthony DeLuca, D-Allegheny County, the minority chairman of the House Insurance Committee, believes the Corbett administration has ?been dragging their feet a bit? with the hope the Supreme Court will strike down the law.
Still, he said Pennsylvania is making adequate progress, and he isn?t worried the state will miss the Jan. 1, 2014, deadline to have the exchange up and running or lose out on grant money.
Rosanne Placey, a spokeswoman for the state Insurance Department, said Corbett?s view on the law isn?t affecting Pennsylvania?s pace.
?While the governor believes that the law requiring the purchase of health insurance is unconstitutional, we must be prepared if the Supreme Court does not strike down the law. Making sure Pennsylvania is prepared in case that happens is the prudent thing to do,? Placey said.
Although the federal law contains far-ranging mandates, it also gives states flexibility in tailoring exchanges to meet states? particular needs.
That means Pennsylvania must make many choices, such as how generous the benefits of health plans offered through the exchange must be, whether it will limit participation to businesses with no more than 50 employees, and who will run the exchange.
Advocates, including Ward, want the exchanges to be set up in a way that shields against excessive influence by the health insurance industry and minimizes the role of politics.
Pennsylvania has decided it will have a state-run exchange, meaning it likely will be run by an existing state agency such as the Department of Insurance or the Department of Public Welfare.
Ward was hoping Pennsylvania would opt to run it with a nonprofit entity, which she believes would provide greater insulation against state politics.
Pennsylvania has settled on some specifics of the exchange, but those won?t be publicly known until the state files its next grant application, which is expected to occur in the next few weeks, said Melissa Fox, a spokeswoman for the Insurance Department.
Ward believes the exchanges will withstand the legal challenges.
?It will certainly make it easier for people to shop for insurance. ... This is an idea whose time has come,? she said.
Most of the opposition to the health care law has come from Republicans, with all the leading contenders for the Republican nomination for president promising to repeal the law, which has many components beyond health insurance exchanges.
Yet in assorted Republican-led states, resistance to the exchanges has thawed, largely because of acknowledgment that the current health insurance market is dysfunctional and exchanges might help, according to Kaiser Health News.
State Sen. Pat Vance, R-Cumberland County, said the law contains ?some good things and some bad things.?
The exchanges are among the good things.
?I think people need to be able to compare health care costs. Right now it is difficult if not impossible to compare health insurance plans. I think the consumer is the winner in that,? she said.
The bad things, in Vance?s view, include too much power placed in the hands of the U.S. Department of Health and Human Services.
The federal law calls for subsidies to make coverage affordable for people earning between 133 percent and 400 percent of the federal poverty level and some small businesses. One of the purposes of the exchange will be to match people and businesses with subsidies.
People who earn less than 133 percent of the poverty level also will receive coverage through the exchange, but it will come from an existing government program, Medicaid.
Pennsylvania?s effort has included three public forums, held over the summer, and comments accepted online that drew input from 814 residents and 204 business owners and health insurance decision makers, according to the Insurance Department.
The surveys suggest a substantial lack of awareness surrounding the exchanges.
Four out of five businesses were ?unaware of the health insurance exchanges and confused by the name.?
Among consumers, only one in 10 was aware of the exchanges.
Among the other findings: 40 percent of Pennsylvania small businesses don?t offer coverage; less than half feel their plan offers excellent value; 56 percent of consumers have insurance through work; and, of those who are uninsured, most lost their job or don?t have access to coverage through work.
About 2 million uninsured Pennsylvania residents are expected to seek coverage through the exchange.
Source: http://www.pennlive.com/midstate/index.ssf/2011/12/marketplace_for_health_insuran.html
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