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Pennsylvania health insurance marketplace: history and news of the state’s exchange

Pennsylvania plans to have its own exchange and a reinsurance program in time for the 2021 plan year

Highlights and updates

Pennsylvania exchange overview

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

Could Pennsylvania be doing more to preserve the Affordable Care Act’s provisions? Compare its efforts to other state-level actions.

Pennsylvania initially opted not to establish its own exchange — although the state seriously considered establishing its own exchange in 2015, when the King v. Burwell lawsuit threatened premium subsidy access in states that didn’t run their own exchanges. So for the first several years of ACA implementation, Pennsylvania has used the federally run exchange at HealthCare.gov. But Pennsylvania enacted legislation (H.B.3/Act 42) in 2019 that calls for the state to transition to running its own exchange platform and also create a reinsurance program that will help to make coverage more affordable.

The state is working on the details, and will need to obtain federal approval (via a 1332 waiver) for the reinsurance program, but the state-run exchange and reinsurance program are expected to be up and running in time for the 2021 plan year. Nevada, New Jersey, New Mexico, and Oregon are also working towards having their own exchanges in 2020 or 2021.

Pennsylvania has eight carriers participating in the exchange market for 2019, although some of them offer plans via multiple subsidiaries. All of the 2018 insurers remained in the exchange, and Ambetter from PA Health & Wellness has joined the exchange for 2019, offering plans in the Philadelphia area. Average premiums in Pennsylvania’s individual market decreased slightly for 2019, and a rate decrease could come again in 2021, thanks to the transition to a state-run exchange and the implementation of a reinsurance program.


Pennsylvania exchange applicants are enrolled in Medicaid if their income is up to 138 percent of the poverty level, and 684,297 people were enrolled in the state’s expanded Medicaid program as of July 2019. This was about 10,000 lower than the enrollment total in late 2018, so enrollment in Pennsylvania’s expanded Medicaid, which took effect in 2015, appears to have stabilized.

The expansion of Medicaid is a major cornerstone of Obamacare; many enrollees supported Trump in the 2016 election, perhaps unaware that the reason they have access to Medicaid in Pennsylvania is a result of the ACA (Obamacare).

Another 314,084 people were receiving premium subsidies to offset the cost of private coverage purchased through the Pennsylvania exchange as of early 2019. All told, there are nearly a million people in Pennsylvania who are receiving either expanded Medicaid or premium subsidies in the exchange to make private coverage more affordable.

Governor Tom Wolf announced in September 2017 that the uninsured rate in Pennsylvania had fallen to 5.6 percent as of 2016 — the lowest it had ever been, and down from nearly 10 percent before the ACA was implemented.

State-run health insurance exchange — and reinsurance — coming in 2021

In 2019, Pennsylvania enacted legislation that calls for the state to establish its own health insurance exchange that will be operational in time for the 2021 plan year (open enrollment begins in November, so the exchange will be up and running by November 2020). This move will save money and also give the state significantly more control over its exchange.

In late August, Governor Wolf announced the appointees for the Pennsylvania Health Insurance Exchange Authority’s board of directors. The group will oversee the implementation and operations of the state-run marketplace.

In a press release earlier in 2019, Governor Wolf’s office noted that the user fee currently collected by the federal government (for the use of HealthCare.gov, the federal call center, etc.) amounts to $98 million in 2019. It’s currently set at 3.5 percent of premiums, and although that will drop to 3 percent in 2020, it will still be $88 million that Pennsylvania insurers (and thus, Pennsylvania insureds) have to send to the federal government to use the federally-run exchange. Wolf’s office noted that the state-run exchange is expected to cost “as little as $30 million per year,” likely in the range of $30-$35 million per year. As described below, Pennsylvania plans to use the savings to fund the state’s portion of a reinsurance program that will bring down the cost of coverage for people who aren’t eligible for premium subsidies.

The state is considering a switch to a state-based exchange using the federal enrollment platform (HealthCare.gov) in 2020, which would reduce the user fee down to 2.5 percent of premiums, instead of 3 percent). The state has indicated that they would keep the fee at 3 percent of premiums and use the excess for “any unexpected transition costs” that arise as the state switches from HealthCare.gov to its own enrollment platform.

In addition to financial savings, states that run their own exchanges also have flexibility regarding their open enrollment schedules, call center operations, and navigator grants. They also have much better access to enrollment data, which can be used to better understand enrollment trends and seek opportunities to better serve the state’s population. Jessica Altman, Pennsylvania’s Insurance Commissioner, testified before the PA House Insurance Committee in May 2019 and outlined the myriad benefits of switching to a state-run exchange.

Pennsylvania’s plan is to also implement a reinsurance program, and to fund the state’s portion of the cost of the reinsurance program with the savings (roughly $40-50 million) that come from switching to a state-based exchange. Assuming the state’s waiver proposal is approved, the federal government would provide a substantial amount of pass-through funding, bringing total funding for the reinsurance program to roughly $150-$250 million (when a reinsurance program results in lower premiums, the necessary premium subsidies are also lower, resulting in savings for the federal government; pass-through funding refers to the process of using a 1332 waiver to allow the state to use the savings, instead of having the federal government keep the money).

The state estimates that with the state-based exchange and reinsurance program, premiums in Pennsylvania’s individual market will be 5 to 10 percent lower in 2021 than they would otherwise have been. Reductions in premiums primarily benefit people who pay full price for their coverage, as premium subsidies (for those who are eligible) rise and fall in line with premiums.

Proposed rate changes for 2020, plus a new insurer in Philadelphia area

In July 2019, the Pennsylvania Insurance Department published the proposed rate changes for 2020. The insurers that sell plans in the Pennsylvania exchange have proposed the following average rate changes:

  • Capital Advantage Assurance: an increase of 1.6 percent.
  • First Priority Health (HMO): a decrease of 0.7 percent.
  • Geisinger Health Plan: a 6.9 percent increase.
  • Geisinger Quality Options: a 7.1 percent increase.
  • Highmark, Inc. (EPO and PPO): a decrease of 1.2 percent.
  • Highmark Health Insurance Company (PPO): 0 percent change (overall rates unchanged from 2019 to 2020)
  • Highmark Choice Company: a decrease of 2.3 percent.
  • Keystone Health Plan East (Independence Blue Cross HMO): a 5.4 percent increase.
  • QCC Insurance Company (Independence Blue Cross PPO): a 5.1 percent increase.
  • UPMC Health Options (PPO and EPO): a 5.2 percent increase.
  • PA Health and Wellness: a decrease of 1.36 percent.
  • Oscar Health: New to Pennsylvania’s market, so no applicable rate change

At ACA Signups, Charles Gaba has calculated an average proposed rate increase of 4.6 percent for Pennsylvania’s individual market, including plans sold off-exchange. Rate proposals are under review by the Pennsylvania Insurance Department, and will be finalized by the fall.

Pennsylvania’s insurance commissioner also announced that Highmark is expanding their coverage area into 14 additional counties for 2020, and Oscar is joining the exchange in the Philadelphia area (Bucks, Chester, Delaware, Philadelphia, and Montgomery counties).

Insurer participation in Pennsylvania’s exchange: 2014-2019

Pennsylvania’s exchange is fairly robust in terms of overall insurer participation, but it’s gone from having four or more insurers offering plans in every county in 2015, to several areas of the state having only one insurer option in 2018 and 2019.

Three carriers that participated in 2014 left the exchange, but four more — including giants Assurant (Time) and UnitedHealthcare — joined the exchange, making Pennsylvania among the many states where consumer choice increased for 2015. But Assurant ceased sales of new policies nationwide on Jun 15, 2015, and UnitedHealthcare exited the exchanges in most states, including Pennsylvania, at the end of 2016. United’s total exchange enrollment in Pennsylvania was 65,159 in 2015.

Aetna also left the exchange in Pennsylvania (and ten other states) at the end of 2016. Aetna insured about 31,000 exchange enrollees in Pennsylvania in 2016, all of whom needed to switch to a new plan during open enrollment for 2017 coverage. Aetna then exited the off-exchange market at the end of 2017. Freedom Life/National Foundation Life also exited the off-exchange market at the end of 2017, but the Pennsylvania Insurance Department confirmed that Freedom Life/National Foundation Life never marketed their plans and didn’t have any enrollees in 2017.

Geisinger Quality Option (PPO) stopped being available on-exchange as of 2017, although Geisinger Health Plan (HMO) continued to be available on-exchange (nationwide, insurers have trended towards offering HMOs and/or EPOs in the individual market, especially in the exchange, instead of PPOs). But for 2019, Geisinger Quality Options has returned to Pennsylvania’s exchange.

Keystone Health Plan Central also stopped offering plans in the exchange in 2017, according to the rate approval notice published by the Pennsylvania Insurance Department. They were not offering silver plans at all in the individual market in 2017, which is a prerequisite of offering coverage in the exchanges under ACA rules. As of 2019, Keystone Health Plan Central is continuing to only offer plans outside the exchange, although they have over 2,000 enrollees.

All of the insurers that offered plans in Pennsylvania’s exchange in 2018 continued to do so for 2019 — and several expanded their coverage areas — and Ambetter (Centene) joined the exchange. Ambetter from PA Health & Wellness is offering plans in the Philadelphia area (Bucks, Montgomery, and Philadelphia counties).

Overall average rates decreased slightly for 2019

Residents in nearly half of Pennsylvania’s counties have more plan options available for 2019, and average premiums for Pennsylvania health plans decreased by an average of 2.3 percent for 2019. But there was considerable variation from one insurer to another: Geisinger’s rates increased by an average of 7.8 percent, while Capital Advantage Assurance Company’s rates decreased by an average of 20.8 percent.

And it’s important to note that the average benchmark premiums in Pennsylvania decreased more significantly than the overall average premiums. Benchmark premiums in Pennsylvania are an average of 15.9 percent lower for 2019 than they were for 2018. Premium subsidies are based on the cost of the benchmark plan, so average subsidies will be smaller in 2019 than they were in 2018, for people whose income remains the same.

To see an example of how this works, consider a 40-year-old in Philadelphia, earning $25,000/year. In 2018, that person qualified for a premium subsidy of $498/month, and had access to bronze plans that were free after the subsidy was applied. But a 40-year-old in Philadelphia earning $25,000 in 2019 is only receiving a subsidy of $324/month. And the cheapest available plan, after the subsidy is applied, is $46/month. This increase in after-subsidy premiums can result from lower benchmark premiums (which require smaller premium subsidies to make the after-subsidy cost affordable), but also from a change in the price range between the benchmark plan and the lower-cost plans. There are a lot of moving parts that factor into the net premiums people pay, and they can all change from year to year — which is why it’s so important to shop carefully each year during open enrollment.

So although overall average premiums in Pennsylvania are slightly lower for 2019, most enrollees (89 percent in 2018) receive premium subsidies, and average subsidies are smaller for 2019. For 2018, the average subsidy amount in Pennsylvania was $625/month, whereas it’s $539/month in 2019. Consumers could protect themselves to some extent by shopping around during open enrollment, but as the example above shows, some consumers likely found that the only available options, after subsidies are applied, are more expensive in 2019 (to be clear, a $46/month health plan is still an excellent deal, as the plan in that scenario would have been $370/month without subsidies)

Approved 2019 rates were lower than insurers originally proposed

Initially, in June 2018, Pennsylvania insurers filed plans with an overall rate increase of 4.9 percent. But they modified their rate filings in July, resulting in an overall average proposed rate increase of 0.7 percent (the Pennsylvania Insurance Department noted that this was because the average load to account for the cost of cost-sharing reductions was reduced from 28 percent to 20 percent). And when the rates were approved, some additional reductions resulted in a slight average decrease for the market as a whole.

In addition to the slightly lower overall average rates, many consumers in Pennsylvania had additional plan options for 2019:

In 31 of Pennsylvania’s 67 counties there are more health insurers offering coverage in the individual market in 2019 than there were in 2018 (a map is available here, showing which counties have additional insurers in 2019). And in addition to a new entrant into the market, four of the five insurers already in the individual market expanded their coverage areas for 2019. Further, the number of counties with just one health insurer offering coverage in the individual market decreased from 20 to eight.


For 2019, the state published the average approved rate changes here.

The Insurance Department’s summaries of the proposed and approved rates made it very clear that the federal government’s actions with regards to the ACA have been destabilizing, and highlighted the “Wolf Administration efforts to combat the effects of sabotage on health insurance markets by the federal government and specifically the Trump Administration to dismantle the Affordable Care Act (ACA).”

The Insurance Department credits the state’s decision to have insurers add the cost of cost-sharing reductions (CSR) only to on-exchange silver plans for 2018 with helping to stabilize the market and resulting in “only a small decline [in exchange enrollment] from the previous year.” Pennsylvania’s exchange market shrank by 9 percent in 2018, while the average across all states that use HealthCare.gov was about 5 percent. But it’s true that adding the cost of CSR only to on-exchange silver plans is the option that protects the greatest number of consumers.

Although overall average rates in Pennsylvania’s exchange declined slightly for 2019, they would have declined even more if the individual mandate penalty weren’t being eliminated and if the Trump Administration hadn’t expanded access to short-term plans and association health plans (AHPs). According to an analysis by the Urban Institute, the combined effect of those changes was expected to drive Pennsylvania premiums 19.2 percent higher in 2019 than they would otherwise have been.

For perspective, here’s a look at how average premiums have changed in Pennsylvania’s exchange over the years:

2015: In 2014, rates for coverage in the Pennsylvania exchange were lower than the national average. As of November 2014, across 13 carriers, PricewaterhouseCooper was reporting an average premium increase of 10.4 percent in Pennsylvania for 2015.  And a Commonwealth Fund analysis found an average rate increase of 12 percent in the Pennsylvania exchange, across all plans and metal levels, for a 40-year-old non-smoker. But the Kaiser Family Foundation looked at the average cost of the benchmark plan for a 40-year-old enrollee in a major metropolitan area in each state.  In the Philadelphia area, the average premium was decreasing by 10.7 percent in 2015.

2016: In October 2015, the Pennsylvania Insurance Department published final 2016 rates for the individual and small group markets, including plans sold through the Pennsylvania exchange. At ACAsignups, Charles Gaba calculated the overall weighted average rate change for 2016, which came out to be 12 percent for the entire individual market.

Statewide, the average benchmark premium (second-lowest-cost Silver plan) was 10.9 percent more expensive in 2016 than it was in 2015. The average subsidy in the Pennsylvania exchange in 2016 was $251/month (lower than the Healthcare.gov average of $290), whereas it was $226 in 2015. But for people who qualify for premium subsidies in the Pennsylvania exchange, the average pre-subsidy premium was $396/month in 2016, which was exactly the average across the 38 states that use Healthcare.gov.

2017: When the final rates were approved, the Pennsylvania Insurance Department noted that the average individual market rates (including off-exchange plans) would increase by 32.5 percent for 2017. And HHS announced in October 2016 that the average cost of a benchmark plan (second-lowest-cost silver plan) in Pennsylvania for a 27-year-old would be 53 percent higher in 2017 than it was in 2016 (significantly more of an increase than the 22 percent average across all the states that use HealthCare.gov).

2018: All of Pennsylvania’s exchange insurers filed rates for 2018, which are available on the Pennsylvania Insurance Department’s website. The initial rate filings were based on the assumption that funding for cost-sharing reductions (CSR) would continue in 2018. In June 2017, the Pennsylvania Insurance Department had published a press release detailing the impact that changes to the ACA would have on premiums for 2018. [Note that the press release indicated that there were five insurers in Pennsylvania’s exchange, while the list of entities offering coverage in the exchange in 2017 is more robust. But several insurer entities are part of the same parent group. If you look at the second column in that list, the four-letter codes at the start of each plan’s tracking number indicate their parent company: CABC = Capital Blue Cross; HGHM = Highmark; GSHP = Geisinger; INAC = Independence Blue Cross; UPMC = UPMC.]

Some of the insurers revised their filings after HHS finalized risk adjustment data in July 2017, and rates were again revised based on the assumption that CSR funding would not continue (this was after it became evident that neither Congress nor the Trump Administration planned to provide commitment for ongoing CSR funding; the Trump Administration later confirmed on October 12 that federal funding for CSR would end immediately). Insurers in Pennsylvania added the cost of CSR to the premiums for on-exchange silver plans. Insurers were also able to create new off-exchange-only silver plans that don’t have the cost of CSR added to their premiums. The final average rate increase was 30.6 percent for 2018; it would have been in the range of 7.6 percent if CSR funding had been committed for 2018.

The Pennsylvania Insurance Department and the CEOs of the five individual market insurers had sent a letter in April 2017 to HHS, asking the federal government to take swift action to ensure stability in the individual insurance markets. HHS had already finalized market stabilization rules earlier in the month, but they didn’t address two of the most pressing issues for insurers: enforcement of the individual mandate, and continued funding for the ACA’s cost-sharing subsidies.

The Pennsylvania Insurance Department addressed those issues in its letter, asking the federal government to vigorously enforce the individual mandate and to confirm that CSR money would continue to flow to insurers. Ultimately, the loss of federal CSR funding ended up being a boon for many consumers, as insurers added the cost to silver plan rates, and that, in turn, resulted in larger premium subsidies for all subsidy-eligible enrollees.

Exchange enrollment: 2014-2019

2014318,077 people enrolled during the first open enrollment period. By the end of the 2014 open enrollment period, private plan Obamacare enrollment in Pennsylvania was the fourth highest out of the 36 states where HHS was running the exchange (trailing Texas, Florida, and North Carolina).

2015: 472,697 people enrolled during the second open enrollment period, for 2015 coverage.

2016: 439,238 people enrolled during the third open enrollment period, for 2016 coverage. Despite the fact that the 2016 enrollment tally accounted for early attrition (through February 1), which the 2015 tally did not, most states saw a year-over-year increase in enrollment at the end of open enrollment 2016 versus 2015 — that was not the case in Pennsylvania. However, Charles Gaba of ACAsignups noted that some of the decline was likely because of people switching from private health plans to Medicaid. Medicaid was expanded in Pennsylvania as of January 2015, but it was initially with a waiver, and didn’t switch to straight expansion until later in the year. The messy nature of the transition to expanded Medicaid in Pennsylvania resulted in some people being enrolled in private plans in 2015 when they were technically eligible for Medicaid instead.

2017: 426,059 people enrolled during the fourth open enrollment period, for 2017 coverage. Across all states that use HealthCare.gov, enrollment was about 5 percent lower in 2017, so Pennsylvania’s decline (about 3 percent) wasn’t quite as significant as the average. The lower enrollment totals across HealthCare.gov states in 2017 were due to a variety of factors, including higher prices, insurer exits from the exchanges/individual market, uncertainty about the future of the ACA, and the Trump Administration’s decision to cut advertising for HealthCare.gov in the final week of open enrollment.

2018: Open enrollment for 2018 coverage began November 1, 2017, and ended December 15, 2017. This was a much shorter open enrollment period than was used in previous years. 389,081 people enrolled in private plans through the Pennsylvania exchange for 2018, which was almost 9 percent lower than 2017’s enrollment.

Most of the states that use HealthCare.gov did end up with lower enrollment for 2018 than they had in 2017, due to the shorter enrollment period as well as sharp reductions in federal funding for exchange marketing, outreach, and enrollment assistance. The perception that the individual mandate had been repealed also served to hamper enrollment for 2018, despite the fact that the penalty repeal didn’t take effect until 2019.

2019: 365,888 people enrolled during the sixth open enrollment period, for 2019 coverage. This was the fourth straight year of enrollment declines, but federal funding for marketing and enrollment assistance had been reduced again in the fall of 2018, and the federal individual mandate penalty was eliminated at the end of 2018, which contributed to enrollment declines in many states. The expansion of short-term health plans also created an alternative for some healthy enrollees (Pennsylvania defaults to the federal rules for short-term plans, so longer short-term policies have been available in the state since the fall of 2018).

Insurers cut commissions, provider reimbursements

As is the case in many states, many insurers in the Pennsylvania exchange lost money in 2014 and 2015. And the risk corridor payments that were supposed to make up some of the 2014 losses ended up being just 12.6 percent of what they were supposed to be. In an effort to avoid selling plans that weren’t proving to be profitable, some carriers in Pennsylvania reduced or eliminated broker commissions for 2016.

Highmark insured nearly 60 percent of the people who enrolled in coverage through the Pennsylvania exchange in 2015. The carrier cut broker commissions to zero in northeastern Pennsylvania, and cut commissions in the rest of the state to $6 per-member-per-month (down from $15 to $25 PMPM previously). Highmark told brokers that they would reinstate commissions for 2017, although their broker commissions were still $0 as of 2018. Highmark was clearly hoping to reduce sales for 2016 — particularly in northeastern Pennsylvania. As such, their loss of market share to UPMC might have been in line with their marketing strategy.

Highmark also announced in February 2016 that they would cut reimbursements to doctors by 4 percent for patients covered under an individual exchange plan.

UPMC Health Plan has cut broker commissions by one-third, to $10 PMPM, for premium network individual plans, noting that “commissions and pricing are determined by competition and market dynamics.”

UnitedHealthcare stopped paying broker commissions for any exchange enrollments submitted January 1, 2016 or later, in any of the 34 states where they offered plans in the exchange (United has since exited the exchanges in nearly all of those states, and now only offers individual market coverage in a few states).

Independence Blue Cross told Pennsylvania brokers in October that they would no longer be paying commissions for new business enrolled through the exchange for 2017, and that commissions would only apply to some HMO plans sold off-exchange.

Cutting commissions has an immediate effect on sales, as brokers are less likely to work with carriers that aren’t paying them, or that are paying far less than other carriers. But this tactic allows the carriers to remain on the exchange (albeit with reduced sales) and keep their options open for sales the following year.

Pennsylvania’s approach to Medicaid expansion

On August 28, 2014, Pennsylvania became the 28th state (including DC) to expand Medicaid under the ACA in an agreement reached with HHS after many months of discussion.  Eligible enrollees were able to begin enrolling on December 1, for coverage effective January 1, 2015.  Interest in the program was very high in the early days of enrollment.  In the first two days alone, 41,500 people enrolled (30,000 of them did so through HealthCare.gov).

Then-Governor Tom Corbett’s office announced the details of the approved Healthy Pennsylvania program, and HHS released an extensive explanation of how the state’s Medicaid waiver would work (a waiver is required if a state is doing anything other than straight Medicaid expansion as laid out in the ACA).  There were three plan options under Healthy PA: One for healthy enrollees, one for sick enrollees, and the third for the newly-eligible population with incomes up to 138 percent of poverty (as opposed to the single Medicaid program for all enrollees that the ACA’s straight Medicaid expansion uses)

But then in November 2014, Democrat Tom Wolf defeated Corbett in the election, and took over as Governor in January 2015. Wolf had long been an advocate of fully expanding Medicaid under the ACA, without any state-specific waiver or modifications. It was unclear initially how the transition would play out, but Wolf said he would abandon Healthy Pennsylvania in favor of straight Medicaid expansion, and Democratic state lawmakers urged him to move quickly in doing so.

In February, Wolf began the process of moving away from Healthy Pennsylvania. The new system, HealthChoices, is the managed care system that Pennsylvania has used for years, although the benefits have been modified. But instead of three different plan designs, the new system has a single benefits package for all Medicaid enrollees. In late April, the state began transitioning people off of Healthy PA and onto HealthChoices, the change took effect on June 1.

Enrollees who were already on Pennsylvania Medicaid prior to the launch of Healthy PA, as well as new applicants, were in the first group of people transitioning to HealthChoices. The rest of the Healthy PA enrollees received notification of the transition over the summer, and their switch to HealthChoices was effective September 1. Enrollment in expanded Medicaid had grown to 684,297 people as of July 2019.

Grandmothered plans

Pennsylvania is among the states that have allowed pre-2014 plans to continue to renew and remain in force until the end of 2020, at the discretion of health insurance carriers.

Pennsylvania allowed insurers to extend existing 2013 policies into 2014 following the policy cancellation compromise that President Obama offered in mid-November 2014. Prior to the President’s announcement, a quarter of a million Pennsylvania residents — about one-third of the individual market in the state — had received cancellation notices.  By the end of November, two Pennsylvania carriers had agreed to extend some existing policies — including one guaranteed-issue, limited benefit plan for low-income residents — for at least the first few months of 2014.

The Pennsylvania Insurance Department’s website has a page that shows rate filings for transitional plans, but the only recent individual market transitional plan filing shown on that page is for Geisinger, for a plan that had 1,791 enrollees as of 2018.

Exchange history

In December 2012, then-Governor Corbett announced Pennsylvania would use the federal health insurance exchange rather than implementing a state-run exchange. Corbett said the U.S. Department of Health & Human Services had failed to provide adequate information, making it irresponsible for the state to proceed on its own. And although the Wolf Administration in Democratic instead of Republican, Insurance Commissioner Jessica Altman, who has been a driving force behind the state’s impending switch to running its own exchange, agrees that the state made the right decision in opting to let HHS run the exchange in the early years.

Earlier in 2012, Corbett had repeatedly indicated his administration preferred a state-run exchange, and feedback gathered by a consultant showed broad-based public agreement. Corbett’s administration proposed establishing several, regional exchanges. However, consumer groups and legislators did not support the concept.

On May 1, 2015, Pennsylvania Governor Tom Wolf announced that Pennsylvania had a contingency plan to create a state-run exchange if the Supreme Court ruled that subsidies could not be provided via the federally facilitated marketplace (Healthcare.gov). Pennsylvania was one of 37 states that used Healthcare.gov in 2015, and subsidies hung in the balance for millions of enrollees in those states, including 382,000 people in Pennsylvania.

On June 15, Pennsylvania was one of three states that got conditional approval from the Obama Administration to operate a state-run exchange. Pennsylvania was the first state to officially announce that they’d create a state-run exchange if necessary in order to protect subsidies in the state. The state’s proposal called for a state-run exchange that uses Healthcare.gov for enrollments (this is the approach currently used by Arkansas, Kentucky, Oregon, Nevada, and New Mexico).

But on June 25, shortly after the Supreme Court issued their verdict upholding subsidies in the federally-run exchange, Governor Wolf announced that the state would withdraw its proposal for a state-run exchange and continue using the federally-run exchange. There was no longer a need for the transition to a state-run exchange, since subsidies continued to be available regardless of who runs the exchange.

By the 2021 plan year, however, Pennsylvania is planning to have its own exchange platform.

Pennsylvania health insurance exchange links

HealthCare.gov
800-318-2596

State Exchange Profile: Pennsylvania< The Henry J. Kaiser Family Foundation overview of Pennsylvania’s progress toward creating a state health insurance exchange.

Health Care Section, Office of the Attorney General
Serves Pennsylvania consumers with health-related problems.
(717) 705-6938 / Toll-free: 1-877-888-4877 (only in Pennsylvania)

Pennsylvania Consumer Assistance Program
Assists people with private insurance, Medicaid, or other insurance with resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(877) 881-6388 / ra-in-consumer@state.pa.us


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.