Lack of information spurred call on exchanges
Would you sign a blank patient consent form before an operation? No.
Would you build a house without a full blueprint? No.
Building a state-based health exchange without the necessary information is not any different.
The federal Patient Protection and Affordable Care Act (ACA) provided that all states must have a health insurance exchange operational by Oct. 1, 2013, in order for consumers to purchase insurance by 2014.
Over the last two years, my administration has been studying the implications of building such an exchange in Pennsylvania. We've sent multiple letters to Kathleen Sebelius, U.S. Department of Health and Human Services (HHS) secretary, asking for clarification. We've held discussions with interested parties, performed studies, lined up vendors, and obtained funding to assist with and prepare for the establishment of a state-based exchange, assuming that it might be the best option for Pennsylvania.
However, building an insurance exchange is not as simple as posting competing plans on a website.
Building it correctly for Pennsylvania means doing it in a cost-effective and sustainable manner. And we need to do that in a way that allows Pennsylvania flexibility in managing our own insurance marketplace.
This is what we've been asking the federal government to grant us as we look at implementing this portion of Obamacare.
Only after the initial decision date had been extended at request of the states did HHS issue some of the draft regulations needed to carry out the necessary research on key elements and functions of an exchange.
In fact, on a recent call with numerous governors, Secretary Sebelius apologized for the lengthy time it has taken to provide proposed regulations, while also mentioning that more drafts were to be expected.
Finally, on Dec. 10, HHS acknowledged a number of the questions we asked in August and provided some partial answers.
But receiving partial responses less than five days before the deadline for a decision only put states in more of a bind.
The draft rules we are reviewing outline major components of an exchange, such as benefits consumers would receive, rates they'd pay, and what's authorized by the state vs. the federal government. Any changes to these drafts could significantly impact the final operations, financing, and governance behind each exchange option.
The continued lack of complete information and delays create an environment of uncertainty that hurts Pennsylvania consumers and businesses trying to plan for the future.
Local control over our insurance market is the number-one reason we were evaluating the creation of a state-based exchange for Pennsylvanians. But, without fully understanding the parameters, price, and future sustainability, the risks involved in taking on this challenge currently outweigh the benefits.
Health-care reform is too important to be achieved through haphazard planning. Pennsylvania taxpayers and businesses deserve more. They deserve informed decision-making and a strong plan that responsibly uses taxpayer dollars.
It is for these reasons that Pennsylvania is electing not to create a state-based exchange, and instead will allow the federally facilitated exchange to operate in the state. By law, the decision to establish a state-based exchange can be reevaluated by states each year.
I understand that Pennsylvanians are very concerned about what changes will occur in their health insurance, and I will make several commitments to you:
My administration will work with the federal government to determine how consumers may compare health plans and what plans may be sold on the exchange.
We will work on what the plans should cover for individuals and small businesses.
We will continue to strive for transparency and coordination in the process and in our decision-making. And we will provide regular updates through the Pennsylvania Insurance Department.
I continue to be committed to commonsense solutions that motivate the private sector to improve the quality and affordability of health care, making it more efficient for consumers, employers, and government.
That's why I want to give consumers the tools they need to take responsibility for their own health - including a marketplace that can meet their insurance needs and is a sustainable solution for Pennsylvania's taxpayers.