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Politics & Government

Health Exchange - What Comes Next

Governor Tom Corbett announced in mid-December that Pennsylvania will not be running its own health-exchange. The online marketplace for health insurance is a crucial component of the Affordable Care Act. The exchange is scheduled to be open for enrollment by October 2013 and will be effective in January of 2014.

With the state not taking control, the exchange instead will be operated from Washington D.C., by the Department of Health and Human Services said Joanne Grossi, Regional Director for the Department. Pennsylvania will not have to return the $33 million dollars it received from the federal government to set up its exchange as some had feared.  Instead, the state might be able to use it for other purposes.  

“Those funds can still be used by the state to develop a state partnership or a federally facilitated exchange as long as the funds are used for activities approved in the grant award so we recognize that some states may transition still between exchange models,” said Grossi.

There is likely to be a lot of collaboration and back and forth between the federal government and the state. For example, the federal government will have to set up a navigator program where it will work on-the-ground with organizations in Pennsylvania to do outreach and enrollment activities for residents. But Grossi said there will still be differences in the way things are run.

“If we’re running it as opposed to the state, then there is a difference in terms of what insurers, for example, are participating in the exchange or what benchmark plan has been identified or what is in the essential health benefits,” said Grossi.

Carolyn Pearson, a Director at Avalere Health, a health policy firm in Washington D.C. said building the exchange and synching it with programs in the state will be a challenge.

“The really big component of course will be working with health plans in each particular state to review their product offerings and make sure that what’s being sold in the exchange really meets minimum requirements,”

The state still has the option to partner with the federal government if it so chooses.