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					Implementing Health Reform in
Pennsylvania:
Issues for Consumers
Sharon Ward, Pennsylvania Budget and Policy Center
October 21, 2010
    Governor’ Health Reform Advisory
              Committee
 Created by Executive Order June 2010
 34 members representing major interests
  and constituencies. 4 consumer reps
 Purpose
    ◦ Advise the Governor’s Health Reform
      Cabinet
    ◦ Assist in shaping health care exchange
    ◦ Offer recommendations to new governor and
      legislature
            Three Topic Areas
 Structure and Function of the Health
  Insurance Exchange
 Access and Enrollment through the
  Exchange
 Other Critical Health Care Issues:
    ◦ Payment Reform
    ◦ Quality Improvement
    ◦ Access to Care
     Four Goals for Consumer
          Representatives

 Develop a consumer-oriented exchange
 Create a consumer-friendly enrollment
  system and insure seamless transitions
 Protect and expand Pennsylvania’s health
  care quality initiatives
 Support access to health care
         What Is An Exchange ?
   Marketplace for individuals and businesses to
    purchase health insurance products
    ◦ Individuals and small groups 2-50 employees
    ◦ Web-based portal and telephone access.
    ◦ Administer tax credits to qualified individuals
    ◦ Facilitate enrollment in Medical Assistance and
      provide seamless transition to programs
    ◦ Aggregate individual and small group customers
      to negotiate with insurers for better rates
    ◦ Set ground rules for insurers who sell on the
      exchange.
                Two Models
   Market Aggregator
    ◦ Utah
    ◦ State of Washington

   Active Purchaser
    ◦ Massachusetts Connector
    ◦ Connecticut Business and Industry Exchange
                Timeline
 October 2010: planning grant awarded
 December 2011: adopt legislation?
 July 2013: begin accepting applications
 January 2014: fully operational
 January 2015: financially self-sustaining
    Key Issues for Consumers

 Avoiding adverse selection (limit cherry
  picking by insurers)
 Governance
 Roll of the exchange: market organizer or
  active purchaser
 Easy enrollment
Guiding Principles: Agreement
 Strong consumer-oriented mission and
  goals
 Governing board and strong executive
  team
 Set minimum standards for plans on
  exchange
 Give Insurance Department rate review
  authority
Guiding Principles: Less Agreement
 Established as an independent entity
 One statewide exchange: merge individual
  and group?
 Negotiate with insurers to reduce price
  and ensure quality?
 Use brokers?
 Exchange for all? Inside and outside sales?
  Your Thoughts?



             Sharon Ward
Pennsylvania Budget and Policy Center
         412 North Third St.
        Harrisburg, PA 17101
         ward@pennbpc.org
          www.pennbpc.org
      www.pahealthaccess.org

				
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posted:10/5/2011
language:English
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