Pennsylvania Must Act Soon to Ensure Kids, Families Can Benefit from a High-quality Health Care Marketplace

Pennsylvania Partnerships for Children Urges Creation of State-Run Insurance Exchange to Pre-empt Federal Action    

HARRISBURG, Pa., Oct. 11, 2012 /PRNewswire-USNewswire/ -- Pennsylvania needs to act quickly to establish a comprehensive, online marketplace so families can explore and compare health insurance options and purchase the best coverage for their children, according to a new report from Pennsylvania Partnerships for Children.

If the commonwealth does not take action soon to meet a federal deadline for setting up this online resource – known as a "health insurance exchange" - the federal government will create the exchange for the commonwealth, meaning the input and expertise of Pennsylvania consumers, health care providers, insurers and policymakers could be overlooked.

"No one has a better grasp of Pennsylvania's health insurance needs than Pennsylvanians, and it would be a shame for that knowledge to be wasted because of a missed deadline," said PPC President and CEO Joan Benso. "The exchange represents a critical opportunity for Pennsylvania to build on its national reputation as a leader in children's health care, but time is running out to do it right."

A high-quality, consumer-friendly exchange could help provide coverage to the more than 153,000 Pennsylvania children who still lack health insurance.

The federal Affordable Care Act (ACA) requires each state to decide by November 2012 whether it will set up its own health insurance exchange or defer this important task to the federal government. The ACA also requires states to have insurance exchanges in operation by January 2014. To date, at least 14 states have moved to create a state-run exchange, including Pennsylvania's neighboring states of Maryland, New York and West Virginia.

While Pennsylvania began taking steps in 2010 and 2011 to set up a state-run exchange, that work faltered in 2012, leaving the commonwealth behind schedule to meet the federal deadline. The delay makes it unlikely the Pennsylvania General Assembly can pass legislation this year to establish an exchange, but it could still be done through an executive order from Gov. Tom Corbett.

"Regardless of how we create Pennsylvania's exchange, further inaction only hurts the commonwealth's families and children," Benso said.

If Pennsylvania opts to not pursue a state-run exchange, PPC recommends a "partnership" exchange with the federal government. A partnership exchange would allow Pennsylvania to oversee key aspects of the exchange related to the management of health plans and consumer assistance, while the federal government would oversee other functions.

PPC's new report, "Health Care Reform and Pennsylvania's Children: A Status Update," outlines several goals of an effective exchange. Among them:

  • The exchange should be a genuine "one-stop shop" for health insurance needs, allowing consumers to examine insurance options, determine eligibility for Medicaid or CHIP coverage, compare plans and buy coverage all through a single website.
  • It should give families concise guidance on health care issues, in part through the use of third-party "navigators" such as schools, churches and similar community-based organizations.
  • The exchange should ensure continuity of coverage, so eligibility in one coverage group does not end before enrollment in another group begins.
  • The exchange should provide children with access to all evidence-based physical and behavioral health benefits.

PPC has monitored the implementation of health care reform in Pennsylvania since the ACA was signed into law in 2010. Our efforts to comprehensively monitor health care reform include the recent launch of "The State of Children's Health Care in Pennsylvania," an annual report that uses objective data to gauge whether the reforms are achieving their desired goals.

"When we strip away the heated rhetoric from the public discussion on health care reform, there is one area in which there should be no disagreement: Pennsylvania must continue to be a national leader in keeping all of our children insured and healthy," Benso said. "It's good for our kids and good for our commonwealth."

For more information on children's health care and related issues, visit PPC's website at

SOURCE Pennsylvania Partnerships for Children