Pa. House Majority Leader Bryan Cutler, R-Lancaster, speaks at a Capitol news conference on 4/17/19 (Capital-Star photo by Stephen Caruso)
By Simon F. Haeder
During the frenzied, final hours of last month’s budget debate, something truly remarkable happened. Legislators from both parties came together to pass a bill that will improve the lives of Pennsylvanians.
I am, of course, talking about the state’s decision to set up its own health insurance marketplace in lieu of relying on the federal government’s healthcare.gov. No doubt, this is one of the most consequential and encouraging outcomes of the recent legislative session. With all the actions taken by the Trump Administration to deliberately depress enrollment, the step comes not a moment too soon.
Much has been written about the wonky details of the policy. In brief, the move will save money for consumers by reducing premiums by 5 percent to 10 percent. As a result, more Pennsylvanians will obtain affordable coverage and gain access to medical care.
With more Pennsylvanians covered, the state’s health care providers, particularly those in rural areas, will have more paying customers. They will have to write off less bad debt for patients unable to pay their bills. Hospital doors will stay open. Individuals will avoid bankruptcy.
What’s not to like about that?
The move will also put more power in the hands of state government—and take it out of the hands of the federal government. With the state in charge, we will likely see more outreach and enrollment efforts including targeted campaigns to bring insurance to hard-to-reach populations and enroll all those eligible for benefits. There may even be efforts to entice more insurance carriers to the enter the Pennsylvania market, fostering competition and reducing premiums even further.
Once more you might ask yourself, what is not to like about that?
But then again hyper-partisanship has prevented the vast majority of states from following Pennsylvania down this road.
Legislators of both parties, particularly House Majority Leader Bryan Cutler, R-Lancaster, and House Minority Leader Frank Dermody, D-Allegheny, should be commended to move beyond partisanship on an issue that has driven division between the parties over the past decade.
No Time to Rest on Laurels
But there is no time to become complacent. Passing and signing the bill was the easy part. A marketplace is much more than a website. It is a massive IT infrastructure project involving multiple levels of government, a slew of departments and agencies, outside contractors, and vast security and privacy requirements. To make things worse, it is connected to a highly controversial policy issue. Setbacks will quickly turn into campaign slogans.
While states like California have shown that states can successfully operate marketplaces, projects can go off the rails rather quickly. And the results can be devastating. Ask Oregon or Maryland. Even California has struggled at times, sinking well over $1 billion into its marketplace.
Having done extensive research on the implementation of health insurance marketplaces, I thus urge the Wolf administration to initially be cautious and deliberate.
Running your own marketplaces is certainly better than relying on a federal government that seems hellbent on running the Affordable Care Act into the ground. Nevertheless, the road can be quite rocky—and there will be potholes.
Yet down the road, when all the IT quirks are worked out, there will also be a time to be bold and innovative. That’s when Pennsylvania should harness the full power of a state-based marketplace by turning it into a one-stop-shop for Pennsylvanians needing assistance.
The possibilities (and benefits) are truly endless.
The state will already be collecting large amounts of information to determine eligibility for health insurance purposes. Why not offer Pennsylvanians the opportunity to take advantage of that information by directly connecting them to other useful services. Voter registration. Supplemental Nutrition Assistance Program. Energy assistance. Earned Income Tax Credit. Educational and job training programs. Tax preparation. You name it.
While other states are eagerly making it harder for their residents to sign up and maintain eligibility for public programs, Pennsylvania should take the opposite road.
Indeed, we should show the nation that what truly lifts people out of poverty is offering them a helping hand to get back on their feet when they need it the most. Streamlining eligibility determination and enrollment across programs will go a long ways to reduce administrative burdens for potential beneficiaries. It will also save the state money and support the Pennsylvania economy.
What is not to like about that?
Simon F. Haeder is an Assistant Professor of Public Policy at Penn State University’s School of Public Policy. He is also a Fellow in the Interdisciplinary Research Leaders Program, a national leadership development program supported by the Robert Wood Johnson Foundation. He writes from State College, Pa.
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