State Health Insurance Marketplace in Pennsylvania

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State Health Insurance Marketplace in Pennsylvania

Introduction

Pennsylvania launched its health insurance exchange in 2021 after state legislators approved it. The exchange platform was created by GetInsured, a company that works with other states such as California, Nevada, Minnesota, Idaho, and Washington (Lin et al., 2021). The exchange platform has 13 insurers who provide the services (Lin et al., 2021). Unlike the Federal government-run exchange, which uses a one-size-fits-all approach, this exchange provides personalized exchange offers that meet the individual community needs. It has a personal navigator program and uses data to develop individualized outreach. This study will evaluate Pennsylvania public exchange, its services, and its effectiveness.

How the Exchange Was Implemented and Its Success

Pennsylvania health insurance exchange was established under Act 42 of 2019. This followed the abolishment of the Federal Exchange which had been acting since 2014 under AHCA (Lin et al., 2021). To implement it, the Pennsylvania exchange was authorized to help facilitate enrollment in qualified plans while the Commonwealth was tasked to implement waivers and reinsurance. Pennie has successfully provided the projected benefits to the citizens of Pennsylvania. At first, it has been able to provide personalized local health policy to the persons. In addition, there has been higher enrollment due to awareness. The state could fund local marketing by using postcards, online ads, emails, paid search, and outreach services offered in both English and Spanish. In 2021, there were 338,000 people enrolled, which was a 5% increase from the past (Lin et al., 2021). This shows that it has been able to increase the enrollment rate significantly.

Another benefit of Pennie is enabling users to access lower premiums. The state exchange products are 14% cheaper than federally sponsored health insurance. This is close to the anticipated target of lowering the premiums by 20% (Yilmaz & Hermane, 2022). The savings from the exchange programs are reinvested in the state through reinsurance pools. The other success of Pennie is that it has allowed everyone access to coverage. The stated-based exchange market is flexible and gives users various options. They introduced the no wrong door policy, which has had over 44,000 households move from their Childrens Health Insurance Program and Medicaid to get more significant savings (Yilmaz & Hermane, 2022). Additionally, Pennie is in contact with 30,000 households who were denied Medicaid to enroll in the best plan that fits their needs (Boden, 2023). This shows that it has opened more access to individuals who need insurance services.

Voluntary or Involuntary Participation

The participation of individuals in Pennie is completely voluntary. Although it is supposed to bring better health care insurance services to the citizens, the state government has used incentives such as lower premiums and customized policies. However, enrollment is purely voluntary, and everyone joins freely at their will (Yilmaz & Hermane, 2022). The state government hopes people will take advantage of lower premiums and more savings to join the program.

Specialized or Carve-Out Services

Pennie offers a wide range of specialized series to its consumers. For instance, it provides two new special enrollment periods for health insurance. Additionally, despite the annual enrollment period, which starts on January 1, it allows people to enroll in case of special events in their lives (Yilmaz & Hermane, 2022). An example is if a person has had a child or is getting married, they can get insurance from the annual enrollment. Pennie offers personalized services to people who are not eligible for Medicaid. It provides birth control, dental, breastfeeding, and vision coverage. There are special medical management programs for people with specific needs such as back pain, weight management, and diabetes.

How it Addresses High-Risk Populations

Pennie addresses high-risk populations by providing special; packages for them. An example of a high-risk group is the aged persons. As age increases, peoples health risk increases, making them require insurance coverage. Pennie has a range of products that address their social needs, such as health insurance, annuities, life insurance, continuing care, travel, and homeowners insurance (Yilmaz & Hermane, 2022). Additionally, they help to determine high-risk populations by mapping them out. For instance, people who live in flood-prone areas within the state will be mapped by FEMA and then allowed to purchase the flood insurance plan. This will ensure that they take the necessary action to ensure the house and measures to mitigate flooding.

Quality Indicators and/or Accreditation, Pay-For-Performance, or Other Pilot Programs Included in the State Exchange

The federal government has approved Pennsylvania health insurance because it meets the minimum requirements needed. It approved pennies through the Insurance Department of the Commonwealth to provide medical and dental insurance (Yilmaz & Hermane, 2022). This helps keep the insurance marketplaces sovereignty and operate within the Federal Acts requirements in providing its services. The Pennsylvania Exchange is governed by the exchange board, consisting of four members appointed by the governor, four appointed by the General Assembly, and a customer advocate. This board ensures that Pennie acts under Commonwealth and Federal Acts (Yilmaz & Hermane, 2022). The healthcare providers who work under this insurance program get Pay-For-Performance bonuses if they exceed the expected levels. For instance, they can be given travel bonuses, cash bonuses, and other incentives for work well done.

Impact of Implementation on Access to Care, State Expenditures, and Quality of Care

The rollout of Pennie has increased access to care for the state residents. It has come up with plans to accommodate people who had earlier been denied Medicare. This implies that more people can access state-based health insurance. In 2021, there was a 5% increase in the number of people enrolled in Pennie compared to federal insurance (Lin et al., 2021). State expenditures were drastically lowered following the adoption of Pennie. From the previous insurance, the federal government took 3.5% of the premiums totaling $94 million in 2019, which is more than the $35 million required by the Commonwealth (Lin et al., 2021). In terms of quality of care, Pennie has improved the quality of services provided by giving incentives to healthcare providers and increasing the financial funding to insured people.

Expected Impact of Affordable Care Act on the Program

The Affordable Care Act has positively impacted Pennies agenda to provide flexible, affordable, and accessible care to its people. It is expected that the combination of the Affordable Care Act and Pennie would increase the number of people enrolled in insurance plans. For instance, it has helped to scrap the annual and lifetime limits, which has impacted over 4.5 million Pennsylvanians. It will also increase medical coverage eligibility for temporary employees with less than 17.5 hours per week (Lin et al., 2021). The Additional Care Act will save catastrophic out-of-pocket medical costs due to Medicaid expansion. Therefore, the number of insured people is expected to rise drastically in the state.

Conclusion

Since the Pennie was rolled out, the state has been able to deliver better care to its residents. The health exchange program has increased enrollment, provided personalized packages, and made health insurance affordable. In addition, it has helped to save a significant amount used by the federal government insurance and give it back to the state. It is expected in the long run that the health exchange program will have a positive impact on the people of Pennsylvania.

References

Boden, S. (2023). Pennie, Pennsylvanias health care exchange, sees slight enrollment decline. 90.5 WESA. Web.

Lin, Y., Monnette, A., & Shi, L. (2021). Effects of Medicaid expansion on poverty disparities in health insurance coverage. International Journal for Equity in Health, 20(1). Web.

Yilmaz, A., & Hermane, A. (2022). Impact of the COVID 19 pandemic on Pennsylvania and its healthcare system. Health Science Reports, 5(3). Web.

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