Aug. 05--Pennsylvania will have a virtual marketplace for individuals and small-business owners to buy health insurance by the beginning of 2014, as required by the federal health care reform law.

The question is, who will be in charge of it?

State political leaders and experts say it's increasingly likely the federal government will have to set up and run Pennsylvania's health insurance exchange, as the marketplaces are called, because state lawmakers and Gov. Tom Corbett have so far failed to act.

"At this point ... the commitment doesn't seem to be there from the administration" on setting up a state-run exchange, said state Sen. Don White, Republican of Indiana and chairman of the Senate Banking and Insurance Committee.

In the past two years, state officials have received more than $34 million in federal grant money, commissioned a lengthy consultant's study, held a series of public forums and publicly stated that Pennsylvania would be better off running its own exchange.

But uncertainty this spring over a Supreme Court challenge to the 2010 Patient Protection and Affordable Care Act, along with continued waiting to see how the November presidential election will turn out, have stalled efforts.

The Supreme Court upheld most of the controversial law on a 5-4 vote in June. Presumptive GOP presidential nominee Mitt Romney has vowed to repeal the law if voted into the White House.

"We are still looking at options in light of the Supreme Court ruling," said Rosanne Placey, spokeswoman for the state Insurance Department, which is charged with planning for the exchange.

Placey's comments were echoed by Corbett administration spokeswoman Kelli Roberts, who said, "We haven't made a firm decision ... We're continuing to do our own analysis."

The comments contrast with a November 2011 statement from the Insurance Department: "After careful evaluation and stakeholder input, Pennsylvania has determined that developing a state-based health insurance exchange will work best for Pennsylvania residents."

It's estimated that about 2 million state residents could buy insurance through the exchange. The Obama administration has argued that exchanges will drive down health insurance premiums because consumers will be able to comparison shop for various health plans.

States have until Nov. 16 to inform the U.S. Health and Human Services Department of their plan to operate a state-based exchange. In those states not ready to operate a state-based exchange, the department said it will operate an exchange in partnership with the state or on its own, said Lorraine Ryan, a department spokeswoman. States will still have the option of setting up their own exchanges for 2015 or later years, said.

Practically speaking, there's not enough time to make the January cutoff because the General Assembly still has to pass bills to set up the exchange, said Samuel Marshall, CEO of the Insurance Federation of Pennsylvania.

"Are they going to enact enabling legislation this fall?" Marshall said. "There aren't enough session days and there are too many unanswered questions."

The federation, a Philadelphia trade group that represents for-profit insurance companies, is supportive of exchanges, But Marshall said it's important that the state not rush into creating an exchange. If it's not consumer friendly, no one will use it.

"First impressions will count," he said.

Money is a chief concern for state officials. While the federal government will provide funding initially to administer a state-based exchange, that money decreases over time, said Roberts, Corbett's spokeswoman.

"We're trying to determine what that cost in the future will be," she said.

Leaving the decisions about a Pennsylvania exchange to Washington bureaucrats worries White, the Indiana senator.

"That's a scary notion to me to have the feds come in and set up anything," he said.

Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or anixon@tribweb.com.

___

(c)2012 The Pittsburgh Tribune-Review (Greensburg, Pa.)

Visit The Pittsburgh Tribune-Review (Greensburg, Pa.) at www.pittsburghlive.com/x/pittsburghtrib

Distributed by MCT Information Services