Pennsylvania remains uncertain on health insurance exchanges [The Times-Tribune, Scranton, Pa.]

Oct. 13--Pennsylvania's insurance commissioner remains cautious about plans for a state-run health insurance exchange, but too much hesitation could risk forfeiting the state-run plan in place of a federally run insurance exchange.

Pennsylvania Insurance Commissioner Michael F. Consedine has a laundry list of questions about federal red tape related to health insurance exchanges required by the Affordable Care Act.

More than a month ago, Mr. Consedine sent a list of 26 questions to U.S. Health and Human Services Secretary Kathleen Sebelius about regulations for the state to create a health insurance exchange. Questions ranged from seeking clarification about vague language in the Affordable Care Act regarding health insurance exchanges to how much it will cost the state under a variety of scenarios.

"As previously communicated to you by Gov. Corbett, Pennsylvania is committed to implementing health reform solutions that work for Pennsylvania -- not a one-size-fits-all Washington solution," Mr. Consedine wrote to Mrs. Sebelius in a letter on Aug. 23.

Unable to get satisfactory answers from the executive branch, Mr. Consedine has traveled to Washington, D.C., to explain his aggravation to anyone with an open ear. He found an audience Sept. 12 at a Congressional hearing on the implementation of the health insurance exchanges.

"The lack of detailed information from HHS has put Pennsylvania, and many other states, in a very difficult position," Mr. Consedine told the House Ways and Means subcommittee on health.

"We're traveling down a road, directionless ... January 2014 is right around the bend."

To comply with the Affordable Care Act's requirement of health insurance exchanges in each state, three options exist for states: a state-run program, a state and federal government partnership or a federally run program.

Creating exchanges

While Mr. Corbett has supported efforts for a state-run exchange, no bill supporting it has passed the state House of Representatives or Senate. Because of limp support from legislators, Mr. Corbett has authorized Mr. Consedine to pursue efforts to plan the state-run exchange.

The intent behind the health insurance exchanges is to create one place where consumers can compare insurance plans in a meaningful way. It will also provide subsidies to help low-income adults purchase insurance. State documents estimate about 1.6 million Pennsylvania residents will buy insurance in 2014 when the exchanges are required to operate in each state.

Currently, 16 states have already established health insurance exchanges, three plan for partnership exchanges, 16 continue to study options, nine have made no significant activity and seven have decided not to create state exchanges, according to the Kaiser Family Foundation, a nonprofit, private group that focuses on major health policy issues facing the United States.

By Nov. 16, Pennsylvania must create an "exchange blueprint" signed by Mr. Corbett and an application to the HHS or risk defaulting, which would mean the federal government would oversee the health insurance exchange in the state.

While health insurance exchanges aren't required to exist until 2014, the November benchmark for states will help determine if Pennsylvania's insurance programs are state run, a state and federal partnership or a product of the federal government.

"Without exchange legislation that meets the requirements of the ACA already in place, there is an increased likelihood Pennsylvania will not meet the federal timetable for implementation," the Kaiser Family Foundation profile on Pennsylvania says, suggesting the state will have a federally-run exchange.

The state has until Jan. 1 to create a state-run exchange that HHS approves. If not, the federal government will run a health insurance exchange in the state.

Deadline looms

The Kaiser Family Foundation tracks each state's progress related to creating health insurance exchanges. After analysis, the foundation seemed skeptical that Pennsylvania will meet the Nov. 16 deadline necessary to pursue a state-run exchange.

Further indicative of lagging progress, Mr. Consedine has announced the state will not use any of a $33.8 million federal grant meant for exchange planning until he gets further clarification from HHS about federal requirements on the health insurance exchange.

"Given the extent and nature of the questions that remain open, we have determined that at this time it would be imprudent for us to continue extensive planning efforts until we receive answers to these items," Mr. Consedine wrote to Mrs. Sebelius on Aug. 23.

The Pennsylvania Insurance Department has used funding from a $1 million federal exchange planning grant awarded in September 2010. When the insurance commissioner's office received requests for an interview, staff said they would not make comments on the record and directed a reporter to information on the office's website.

Recently, the insurance commissioner's office posted online a 45-page report on essential health benefits by Deloitte Consulting LLP, which studied health insurance options currently available in the state. Mr. Consedine said in letters that the report will be submitted to the HHS.

Mr. Consedine has sent a follow-up letter to Mrs. Sebelius saying that he would like detailed responses to his questions soon.

Waiting game

As the state has stalled on planning related to the health insurance exchanges, insurance companies wait for guidance to see how they should respond. Elena Kambitsi, Ph.D., vice president of product development, marketing and individual sales at Blue Cross of Northeastern Pennsylvania, said the company hasn't determined what it will offer as part of the health insurance exchange. Dr. Kambitsi said the company must wait until the government determines core benefits, which the government requires all insurers to include in plans.

"Until they are known, we are working hard to model new plans for the exchange that are similar to the plans our customers are purchasing and are comfortable with today," Dr. Kambitsi said.

Shannon Mace, a Philadelphia-based public health attorney who runs the blog PublicHealthEsq.com, said there is ambiguity in some of the federal guidelines related to health insurance exchanges. However, she believes the state may be intentionally stonewalling the process for political reasons. The major deadline on the exchanges isn't scheduled until after Nov. 6 presidential elections.

"I don't think we're going to see a lot of movement from the state related to the exchange until after the election," Ms. Mace said.

Contact the writer: rward@timesshamrock.com, @rwardTT on Twitter

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