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Pennsylvania health insurance

PA uninsured rate decreases, questions about Trump effect on ACA increase

Pennsylvania’s delayed Medicaid expansion in 2015 made a swift impact on the state’s uninsured rate, which was already among the lowest in the nation. But change is on the horizon for the Affordable Care Act in 2017 under the Trump administration and GOP-controlled Congress, leaving many to wonder what could happen to their health insurance coverage. We do not yet know what parts of the ACA will be repealed and what replacement will be implemented, but we do have an idea of what you can expect now and in the months and years ahead.

It is important to remember that Obamacare remains in effect (more than 300,000 people signed up for ACA plans after Trump was elected) and Americans will need health insurance coverage for 2017. As open enrollment continues through January 31, Pennsylvanians can purchase ACA-compliant plans on and off the state’s federally facilitated health insurance exchange. Those who want coverage starting January 1, 2017, should enroll by December 15, 2016. Subsidies are available to help eligible consumers reduce their monthly premiums when they buy plans from Pennsylvania’s exchange.

Health insurance carriers, rates for 2017

Many of the nation’s health insurance exchanges have seen carrier exits for 2017, and Pennsylvania is no exception. UnitedHealthcare and Aetna will leave the state’s individual market at the end of 2016, Geisinger Quality Options PPO will not be available on-exchange for 2017, and Keystone Health Plan Central will not offer exchange plans in the state. However, Pennsylvania’s exchange is still one of the most robust when it comes to carrier options.

Of the state’s nine rating areas, four will have at least seven carriers available on the exchange. No area will have fewer than three carriers.

The carriers and their approved average 2017 rate increases are as follows:

  • Capital Advantage Assurance – 43.3 percent rate increase
  • First Priority Health (HMO) – no rate change
  • First Priority Health (PPO) – 45.8 percent rate increase
  • Geisinger Health Plan – 42.08 percent rate increase
  • Highmark, Inc. (EPO and PPO) – 50.1 percent rate increase
  • Highmark Health Insurance Company (PPO) – 50.1 percent rate increase
  • Keystone Health Plan Central (Independence Blue Cross HMO – 27.97 percent rate increase
  • QCC Insurance Company (Independence Blue Cross PPO) – 28.38 percent rate increase
  • UPMC Health Coverage, Inc. (HMO) – 0.93 percent rate increase
  • UPMC Health Options (PPO and EPO) – 22 percent rate increase

Average individual market rates for Pennsylvania’s on- and off-exchange plans increased by an average of 32.5 percent for 2017. All Pennsylvania exchange enrollees are encouraged to shop around rather than automatically re-enroll. Those who are eligible for premium subsidies and enroll in exchange-based coverage may see rate increases offset by premium tax credits.

Pennsylvania health ratings

In 2015, America’s Health Rankings placed Pennsylvania 29th out of the 50 states in terms of overall health. The state’s rating is helped by its number of uninsured, 10th lowest of the ranked states; number of primary care physicians, 11th best; and number of dentists, 19th best.

Pennsylvania fared slightly better in The Commonwealth Fund’s 2015 Scorecard on State Health System Performance. The state came in 20th out of the 50 states and DC, up from 22nd in 2014. The Pennsylvania Scorecard provides more in-depth details showing how the rating was determined.

Trust for America’s Health has summarized a variety of public health data pertaining to Pennsylvania in their 2016 edition of Key Health Data, which contains information on specific diseases, health factors, and outcomes.

The Robert Wood Johnson Foundation also analyzed public health data at the county level, ranking Pennsylvania’s counties on this interactive map. The southeast part of the state has some of the highest-ranking counties for both health factors and outcomes.

How did Obamacare help PA residents?

Before the ACA was implemented, the uninsured rate in Pennsylvania was 11 percent, the seventh-lowest rate in the nation.

Initially, the state did not expand Medicaid, which resulted in a small decline in its uninsured rate during 2014, the year the ACA took effect. About 360,000 people obtained coverage, including Medicaid/CHIP and private plans, through the Pennsylvania exchange during the first open enrollment.

Pennsylvania expanded Medicaid in 2015, initially with a waiver, and saw even more residents gain coverage. From 2013 to 2015, Pennsylvania’s uninsured rate dropped to 7.4 percent. Nationwide, 11.7 percent of individuals were uninsured.

As of 2015, there were still 994,000 nonelderly Pennsylvania residents who were eligible for ACA coverage but remained uninsured – nearly half (48 percent) of them were eligible for Medicaid, and 18 percent qualified for tax credits to help lower their monthly exchange-based insurance premiums.

In September 2015, Pennsylvania was awarded more than $3.1 million in Navigator grants to help six organizations provide outreach and enrollment assistance through 2018.

Pennsylvania enrollment in qualified health plans

In the fall of 2013, the Kaiser Family Foundation estimated that 1,276,000 Pennsylvania residents could potentially buy qualified health plans (QHPs) through the exchange and that 715,000 of them would qualify for premium subsidies. By the end of the first open enrollment period, 318,077 people purchased private plans in the Pennsylvania exchange, and 81 percent received premium subsidies.

As of March 2015, Pennsylvania’s effectuated exchange enrollment was 412,347. About 78 percent of those enrollees were receiving premium subsidies on average of $248 per month.

Pennsylvania and the Affordable Care Act

In 2010, both of Pennsylvania’s U.S. Senators, Democrats Robert Casey and Arlen Specter, voted in favor of the ACA. In the U.S. House, eleven Democrat representatives voted yes, while seven Republicans voted no. Specter has since been replaced in the Senate by Republican Pat Toomey, and the U.S. House now includes just five Pennsylvania Democrats, and 13 Republicans.

At the state level, the overall population in Pennsylvania has a Democratic majority, but the Republicans hold a majority in the state’s House and Senate. Former Gov. Tom Corbett was also a Republican and not an ACA supporter. As such, the state defaulted to a federally facilitated health insurance exchange.

But unlike many Republican governors, Corbett pursued the possibility of Medicaid expansion under the ACA. Corbett submitted his proposal for a modified version of Medicaid expansion – dubbed Healthy Pennsylvania – to HHS in February 2014.  It took half a year of negotiations, but on August 28, 2014, Corbett and HHS announced that they had reached an agreement, and Pennsylvania became the 28th state, including DC, to accept federal funding to expand Medicaid and thereby cover residents with incomes up to 138 percent of poverty.

Corbett lost the 2014 gubernatorial election to Tom Wolf, a democrat. Gov. Wolf was sworn into office January 20, 2015. Shortly after he assumed office, Wolf began to do away with Healthy PA in favor of traditional Medicaid expansion, which had been a campaign promise.

PA Medicaid/CHIP

By July 27, 2015, about 439,000 Pennsylvanians had enrolled in the state’s expanded Medicaid program – expanded coverage did not take effect until January 2015. The state saw a 12 percent increase in its average monthly Medicaid enrollment from 2013 to 2015.

However, the expansion of Medicaid has intensified that increase. Pennsylvania’s monthly Medicaid enrollment now averages 2,832,353 – a 19 percent increase between 2013 and June 2016.

Medicare in the Keystone State

Pennsylvania Medicare enrollment reached 2.5 million in 2015, which is 20 percent of the state’s population. About 17 percent of the U.S. population is enrolled in Medicare. In the Keystone State, 84 percent of Medicare beneficiaries qualify based on age alone and 16 percent qualify due to a disability; this distribution is also on par with the national average.

Medicare spends about $9,179 annually per Pennsylvania enrollee, which is just above the $8,970 per enrollee spent nationally. As of 2009, the state ranked fifth in overall Medicare spending with $23.7 billion per year.

Pennsylvanians that qualify for Medicare can select a Medicare Advantage plan instead of Original Medicare, and about 40 percent do so. About 41 percent of Pennsylvania’s Medicare beneficiaries are enrolled in stand-alone prescription drug benefits through a Medicare Part D plan. Nationally, about 31 percent of Medicare beneficiaries choose a Medicare Advantage plan and 45 percent select a Rx plan.

State-based health reform legislation

Here’s a summary of recent Pennsylvania legislation related to public health and healthcare reform: