Pa.'s Healthcare Insurance Exchange achievements (Gettysburg Times op-ed)

As the new year begins, let us not forget the outgoing Wolf Administration’s important achievements that addressed the healthcare insurance needs of Pennsylvanians. The first was the expansion of the Commonwealth’s Medicaid program in 2015, as only a handful of states had done at that time. The second was the development of “Pennie,” our state’s own Affordable Care Act (ACA) healthcare insurance exchange. The objective in creating Pennie was to reduce operating costs of the ACA for Pennsylvanians and make comprehensive health insurance more accessible and affordable for those who did not have employer-based insurance.

Zachary Taylor, director of Rhode Island’s successful state exchange, was hired to be Pennie’s Executive Director and to lead the implementation effort. Michael Humphreys, commissioner of the Pennsylvania Insurance Department, became an integral partner for Pennie. This piece focuses on some of the ambitious goals and outcomes of Pennie in its first two years.

Pennie’s rollout in November 2000-January 2021 went smoothly, but was soon followed by the COVID epidemic, which created challenges as well as opportunities for the new program. By late March, the number of uninsured Pennsylvanians had grown to over 700,000, largely due to job losses. More than 230,000 of these people were eligible for our Medicaid program, leaving 470,000 potentially uninsured, and eligible for Pennie.

Following the example of HealthCare.gov, the national platform for ACA exchanges, Pennie opened a similar Special Enrollment Period through May 15 to allow newly unemployed people to apply.

In March 2021, President Biden’s American Rescue Plan (ARP) was signed into law, creating additional opportunities for Pennie to grow. With some system changes, Pennie was able to deliver the generous ARP subsidies to both new and returning customers. By the end of the 2022 Open Enrollment period, nearly 375,000 Pennsylvanians were covered, an 11 percent increase over 2021. Ninety percent of customers now had financial assistance, with average monthly savings of $500 each. More than 35,000 middle-income individuals qualified for the first time for financial assistance, lowering their monthly insurance costs by an average of $252. (Source: Pennie leadership letters to legislators and the Pennie Annual Report for 2021)

In 2020, Pennsylvania’s uninsured rate was 5.4 percent, the lowest it had been in years. This was likely due to Wolf’s expansion of the Medicaid program as well as Pennie’s “no wrong door” policy of helping eligible people sign up with Medicaid and/or CHIP if they were not eligible for the ACA.

In 2021, the uninsured rate was stable, even with massive losses of employment-based health insurance. Two things were at work here. The ARP, of course, helped a great deal. So did Pennie’s ability to guide people to the appropriate health insurance plan and its stepped-up efforts to improve access to healthcare coverage for the uninsured and underinsured. To broaden its reach, Pennie created an advertising campaign to raise statewide awareness for anyone seeking affordable, high-quality healthcare coverage. The campaign included building Pennie’s presence on social media platforms.

Pennie’s efforts to reach underserved, vulnerable communities included expanding language access in the application and enrollment process. The content of pennie.com became available in 10 different languages. Customers used the Spanish version of the application 2,919 times during Open Enrollment in 2021-22, resulting in a nearly 3,000 increase in Hispanic/Latino enrollments. In 2021, Pennie partnered with the Pennsylvania Department of Health and the Harrisburg YMCA on a Health Equity Tour, hosting nearly 70 free in-person events across the Commonwealth, providing a safe place to learn about health services and insurance enrollment options. These events included COVID testing and vaccination services.

This is just a snapshot of what Pennie has done to improve health insurance in Pennsylvania. The passage of Biden’s Inflation Reduction Act in 2022 ensures that the ACA subsidies will be extended at least through 2025. Barring any successful attempts to end these subsidies, and the ACA as a whole, by a Republican-led Congress, Pennie can continue providing many more Pennsylvanians with comprehensive, affordable health insurance.

Jeanne Duffy, Ph.D., has served as a college professor, an analyst and project manager for several large companies, and a college administrator in charge of foundation and government support. She is a member the DFA Steering Committee and both the Healthcare and the Government Accountability task forces.