Affordable Care Act, Health Insurance Exchange, Health Reform

Health Insurance Marketplace | Help!

Starting tomorrow many individuals who have never purchased health insurance before will be able to do so through the new Health Insurance Marketplaces established by the Affordable Care Act. If you will be using the Marketplace or assisting others there are many resources available. Below is a list of resources that I find most helpful:

1. Find Local Help from

  • Simply enter your zip code and you will be given a list of local organizations that can help individuals.
  • Results can be narrowed by organizations that administer Medicaid or CHIP or that have language access capability.

2. Helping Consumers Understand and Use Health Insurance in 2014 from the Institute of Medicine:

  • This 16 page report clearly explains the Health Insurance Marketplace and other changes occurring due to the Affordable Care Act.
  • Written in simple language and contains helpful graphs/charts/illustrations.
  • Very useful for anyone who anticipates helping individuals with the Marketplace.

3. Subsidy Calculator from Kaiser Family Foundation:

  • Interactive tool allows individuals to enter their income information to find out if they qualify for a tax subsidy or tax credit to purchase health insurance in the Marketplace.

4. How do I get an exemption from the fee for not having health coverage? from

  • Provides easy-to-understand information about the exemptions that exist to the individual mandate provision of the Affordable Care Act.
  • Explains that an exemption exists for individuals in states that do not expand Medicaid eligibility. Individuals that would otherwise become eligible will not face a penalty for not having coverage beginning in 2014.
Affordable Care Act, Health Insurance Exchange, Health Policy, Health Reform, Pennsylvania

Pennsylvania State-Operated Health Insurance Exchange- Not Happening

PA Will Miss Health Insurance Exchange Deadline

On Wednesday, October 17, Pennsylvania Health Insurance Commissioner, Michael Consedine stated that the Commonwealth will not be meeting its November 16th deadline to submit an Exchange Blueprint to the Health and Human Services (HHS) Department. Because of this, the State will not be able to establish its own state-based exchange but must instead either default to a Federally Facilitated Exchange (FFE) or partner with the federal government to establish a Partnership FFE.

Health Insurance Exchange, Health Reform, Pennsylvania

Pennsylvania’s Health Insurance Exchange Progress (or lack thereof)

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, 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.