Health insurance in Pennsylvania
- Pennsylvania uses the federally facilitated marketplace and enrolls through HealthCare.gov — for now.
- Pennsylvania plans to be running its own exchange in time for the 2021 plan year.
- Pennsylvania is also working to establish a reinsurance program, using federal pass-through funding and the savings generated by switching to a state-run exchange.
- Open enrollment for 2020 health plans has ended, although Pennsylvania residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
- Short-term health plans are available in Pennsylvania with initial plan terms up to 364 days.
- Twelve insurers are offering coverage through the Pennsylvania exchange.
- About 332,000 Pennsylvanians enrolled in 2020 coverage through the state exchange.
- In 2015, ACA’s Medicaid expansion took effect in Pennsylvania; nearly 700,000 people are covered as a result.
- Nearly 2.75 million Pennsylvania residents are enrolled in Medicare.
Pennsylvania’s health marketplace
Pennsylvania initially opted not to establish its own exchange, so the state utilizes the federally run exchange at HealthCare.gov. But that’s expected to change by the fall of 2020, when Pennsylvania plans to be running its own exchange.
The state enacted legislation in 2019 to authorize the transition away from HealthCare.gov. By switching to its own exchange, Pennsylvania expects to save up to $50 million per year, which will be used to cover the state’s portion of the cost of a reinsurance program. The state will also gain numerous other benefits in terms of flexibility and control over the marketplace, described here by Jessica Altman, Pennsylvania’s Insurance Commissioner.
Assuming the state’s reinsurance waiver proposal — which had not yet been submitted to the federal government as of early March 2020 — is approved, the federal government will provide pass-through funding that will cover the majority of the cost of the reinsurance program (because reinsurance will result in lower premiums, premium subsidies will also decline, 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).
Pennsylvania estimates that the transition to a state-based exchange and the implementation of a reinsurance program will result in individual market premiums about 5 to 10 percent lower in 2021 than they would otherwise have been.
Open enrollment for 2020 health plans has ended, although residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
Enrollment in Pennsylvania’s exchange grew from 2014 through 2016, but it has decreased each year since then, mirroring a national trend towards lower enrollment under the Trump administration in states that use HealthCare.gov. The enrollment decline continued for 2020, when 331,825 people enrolled in plans during open enrollment.
Read our full overview of the Pennsylvania health insurance marketplace.
Medicaid in Pennsylvania
Although Pennsylvania was a year behind many other states, the state accepted ACA’s Medicaid expansion and it took effect on January 1, 2015. As of early 2020, enrollment under Pennsylvania’s Medicaid expansion stood at 687,460 people.
Read more about Medicaid expansion in Pennsylvania.
Short-term health insurance in Pennsylvania
Pennsylvania does not have state regulations pertaining to the duration of short-term health insurance plans, so the state defaults to the federal regulations.
That means insurers in Pennsylvania can offer short-term plans with initial terms up to 364 days and the option to renew for a total duration of up to 36 months.
Read more about short-term health insurance in Pennsylvania.
How did Obamacare help PA residents?
In 2013, before the bulk of the ACA’s regulations were implemented, the uninsured rate in Pennsylvania was 9.6 percent — well below the 14.5 percent national average uninsured rate at that point.
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, but then as straight expansion once Gov Wolf took office), and saw even more residents gain coverage. By 2017, Pennsylvania’s uninsured rate dropped to 5.5 percent, and it remained at that level in 2018. Nationwide, 8.9 percent of individuals were uninsured as of 2018.
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 delegation from Pennsylvania is evenly split, with nine Democrats and nine 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, although it’s transitioning to a state-run exchange under the Wolf administration.
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 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 on 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. Pennsylvania has had Medicaid expansion as called for in the ACA ever since, as opposed to the modified version of expansion that Corbett had overseen.
And under Wolf’s administration, the state is pursuing a transition to a fully state-run exchange and a reinsurance program, which are expected to work in tandem to reduce individual market health insurance premiums in the state.
Medicare in the Keystone State
As of late 2019, there were nearly 2.75 million Pennsylvania residents enrolled in Medicare. You can read more about Medicare in Pennsylvania, including residents’ choice of Original Medicare or Medicare Advantage, as well as the state’s requirements for Medigap plans.
Pennsylvania health care reform legislation
Scroll to the bottom of this page to see a summary of recent health care reform legislation in Pennsylvania.
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.