Health insurance exchanges have the potential to transform the health insurance market for consumers, especially for the 1.2 million uninsured Pennsylvanians under the age of 65. But many questions remain about the best model for the commonwealth.
In a recent letter to Pennsylvania Insurance Commissioner Michael Consedine, the Pennsylvania Medical Society (PAMED) supported the concept of a Pennsylvania health insurance exchange and offered input on how it should be created and implemented.
Under the federal Patient Protection and Affordable Care Act (ACA), each state has the option to enact a statewide health insurance exchange or else a federal exchange will be made available to its citizens. The ACA would extend health care coverage to hundreds of thousands of additional Pennsylvanians beginning in 2014, either through Medicaid or a state health insurance exchange.
Based on principles developed by the American Medical Association (AMA), PAMED recommends that the Pennsylvania exchange:
- Not limit patients and their physicians from making treatment decisions regardless of benefit design
- Be self-supporting
- Have uniform solvency requirements
- Not receive special advantages from government subsidies
- Include adequate physician payment rates established through meaningful negotiation and contracts for both public and private programs
- Not require provider participation
- Not restrict enrollees’ access to out-of-network physicians
The state exchange should provide for a link between its public payers along with the individual and employer-based insurers so that coverage through publicly funded programs such as Medicaid and CHIP is seamless.
PAMED also recommended that the state exchange be an independent public agency or corporation governed or overseen by the state with actively practicing physicians in its governing body. It should also require qualified health plans to maintain adequate physician networks.