State says it can use existing federal tools to transition to state-based health plan marketplace

In preparation for an imminent Supreme Court ruling, the Pennsylvania Insurance Department recently said it can transition to a state-based marketplace using existing federal enrollment and eligibility tools, according to The Hospital & Healthsystem Association of Pennsylvania (HAP).

Pending the outcome of King v. Burwell, the state submitted its plan to the federal government with accommodations in place in case of an adverse ruling. The court will decide whether individuals who buy health insurance through federally assisted marketplaces will be permitted to obtain subsidies to help pay for coverage.

Currently 382,000 Pennsylvania citizens receive such subsidies. If the court rules against it, maintaining coverage could become difficult; hence, the Commonwealth plans to pursue a state-based insurance marketplace.

The Kaiser Foundation has estimated that Pennsylvania ranks fifth in the nation in the number of individuals subject to the subsidy loss, and that premiums could increase by 177 percent without the tax credit.

The Kaiser Foundation also has developed an interactive tool providing detailed enrollment analysis by zip code. Such information can be useful to hospital and health system staff as they initiate outreach activities to engage underserved residents. Demographic data indicates numbers of enrollees as well as predictions regarding the number of remaining potential health care beneficiaries who may enroll.

The Supreme Court decision is expected later this month.

Organizations in this Story

The Hospital & Healthsystem Association of Pennsylvania

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