Growing up, I remember watching the game show “Let’s Make a Deal,” the centerpiece of which was forcing contestants to select an unknown prize: To essentially gamble on making the right choice. Would it be what’s behind curtain No. 1 or door No. 2 – the new car or the live llama?
For the past two years, we’ve been asked to play a version of “Let’s Make a Deal” with the U.S. Department of Health & Human Services (HHS) on the issue of whether Pennsylvania would build a state health insurance exchange of its own or instead opt to have the federal government operate an exchange for us.
The federal Patient Protection and Affordable Care Act (ACA) provided that all states must have a health insurance exchange in operation by Oct. 1 in order for consumers to purchase insurance by 2014.
Building an insurance exchange is not like helping my 7-year-old son with a Lego project. Instead, the ACA requires the creation of an entirely new way of purchasing health insurance using technologies and distribution systems that currently don’t exist in most states and that would cost millions of taxpayer dollars to build.
Doing it correctly for Pennsylvania also means doing it in a cost-effective and sustainable manner, in a way that allows Pennsylvania flexibility in managing the operations for our insurance marketplace.
Over the past two years, the Pennsylvania Insurance Department has been trying to understand the implications of building such an exchange. We’ve held discussions with interested parties, performed studies and secured vendors and funding to assist with and prepare for the establishment of a state-based exchange, with the assumption that it might be the best option for Pennsylvania. All options were put on the table and considered.
Four months ago, after repeated requests for more information, we memorialized our primary outstanding questions for HHS. Fewer than five days before the deadline for states to declare their intentions regarding exchanges, HHS issued a general letter with some answers and guidance. There was not enough information, however, and it was given too late to be useful.
States are consequently being asked by the federal government to make uninformed choices – do you want to go with what’s behind curtain No. 1 or opt instead for box No. 2? Health insurance is not a game for the millions of Pennsylvanians who depend on it.
Gov. Tom Corbett simply wasn’t ready to gamble on the unknowns associated with a state exchange when it involves the health care of Pennsylvanians and millions of taxpayer dollars. It is for those reasons that Pennsylvania is electing not to create a state-based exchange, instead opting for the choice where there is more certainty in having a federally facilitated exchange.
We understand the frustration of Pennsylvanians wanting to know what will be happening with their health insurance. We share that frustration. We are, however, committed to working through all the uncertainty and getting consumers what they need to make informed decisions.
By law, the decision to establish a state-based exchange can be re-evaluated each year. But, consumers, employers, medical providers and health insurers need to understand now what will be happening in 2014. Without timely and comprehensive guidance from HHS, this is the only reasonable decision.
We will work with the federal government to determine how consumers may compare health plans and what plans may be sold on the exchange. We will work on what the plans should cover for individuals and small businesses. We will continue to keep Pennsylvanians informed and engaged every step of the way.
Improving access and affordability of health insurance remains a priority for the Corbett administration, but we’re going to do so in a deliberate and considered manner.
This issue is far too important to treat like a game show.
Michael Consedine is insurance commissioner for Pennsylvania.