Pennsylvania Gov. Tom Wolf and the state's insurance commission have opted not to follow Trump administration guidance allowing insurers to sell individual health policies that would not be regulated through the Affordable Care Act.
The U.S. Department of Health and Human Services issued the "State Relief and Empowerment Waivers" guidance Monday. The department, run by former drug company executive and President Donald Trump appointee Alex Azar, summarizes the waiver option as a way for states to address state-specific problems, increase coverage options and develop strategies to cut health care spending.
"One of the administration's priorities is to empower states by providing tools to address the serious problems that have surfaced in state individual health insurance markets with the implementation of the Patient Protection and Affordable Care Act," the DHHS document states.
The federal guidance comes as mid-term elections loom, and as discussions around the ACA and pre-existing conditions heat up among political candidates. It also comes less than two weeks before 2019 ACA insurance open enrollment begins.
Pennsylvania will not apply for waivers because the plans would put consumers at risk, said Ron Ruman, Pennsylvania Insurance Commission spokesman.
"People may think that they're buying something that's going to give them that coverage only to find out, unfortunately, when they have a large medical bill, that they're not covered," Ruman said.
In Pennsylvania, plans on the ACA marketplace must meet strict coverage requirements signed into law by President Barack Obama in 2010. Ruman said adopting the waiver system would allow insurers to sell coverage that didn't meet those requirements.
Health insurers in the Commonwealth aren't lobbying for off-exchange individual coverage, said Sam Marshall, president and CEO of the Pennsylvania Insurance Federation, which represents insurance companies.
Marshall said insurers initially scrambled to adopt the Affordable Care Act but have since adjusted to it, with some companies invested in its success.
"The real challenge is that the ACA ultimately only works if everybody buys in," Marshall said.