Prior to the U.S. Supreme Court’s announcement of its decision to uphold most provisions of the Affordable Care Act (ACA) on June 28th, many states, especially those who were plaintiffs in the landmark case, failed to make substantial progress in designing and implementing health insurance exchanges (HIX). Pennsylvania, being one of the plaintiff states, has not revealed much regarding its plan for a state HIX. A recent letter from Pennsylvania’s Insurance Commissioner, Michael Consedine, to Health and Human Services (HHS) Secretary Sebelius provides us with some insight. Unfortunately, the letter validates suspicions that the Commonwealth has done little in terms of preparing for HIX and other ACA provisions that are set to go into effect in 2014.
The letter challenges the Secretary’s lack of guidance to the States regarding implementation of the ACA. Commissioner Consedine cites the changes associated with the ACA as being “fundamental and potentially disruptive to Pennsylvania’s marketplace” and that “we must be mindful of the consequences, both fiscal and policy. . . .” He later cites the fact that according to the ACA, State HIX must be self-financing by 2015, a major concern. However, according to Healthcare.gov, Pennsylvania has received $1 million in planning grants and $33.8 million in Exchange Establishment grants. So what has the Commonwealth done with the money? Well, nothing with the Establishment grants. Commissioner Consedine concluded his letter stating that until more information is given by HHS, Pennsylvania will withhold expending any of the Establishment funds.
States are required to have their HIX plans ready for implementation by January 1, 2013. With many states waiting on the election, it is unlikely that many states will meet this requirement. Alternatives for states that have not established their own state-run HIX is to have the Federal government operate an exchange in the state or to enter into a partnership with the Federal government. Commissioner Consedine listed 26 questions for Secretary Sebilius to answer in his letter to her. Many of the questions centered on getting details about the Federally-Facilitated Exchange (FFE) or a Partnership FFE. With deadlines looming and little progress made this appears to be the direction Pennsylvania is headed.