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Responding to New Federal Guidance, Governor Vows to Safeguard ACA Consumer Protections

October 29, 2018

Last week, Governor Wolf announced that Pennsylvania will work to maintain consumer protections required by the Affordable Care Act (ACA) in the face of the Trump Administration’s new guidance for state innovation waivers.

The new guidance loosens the rules around the use of Section 1332 waivers to allow states to opt out of certain ACA requirements related to the comprehensiveness and affordability of coverage. According to the Governor’s statement, Pennsylvania will not seek such a waiver because it could lead to the destabilization of the health insurance marketplace and undermine access to comprehensive, affordable health coverage.

Under the new waiver guidance, state governors will have much more power to overhaul their insurance marketplaces. State legislatures will no longer have to approve state waiver plans.

As a result, consumers could find that their health insurance marketplace:

  • Offers short-term limited duration plans, association plans, and other plans that skirt the ACA’s “minimum essential coverage” requirements, including coverage for pre-existing conditions, and have lower premiums
  • Allows the use of federal subsidies to help pay for these less comprehensive plans
  • Provides bigger subsidies for younger, healthier consumers, to encourage their participation in the marketplace—at the expense of those with pre-existing conditions

Consumers with pre-existing conditions and more complex health needs could be priced out of comprehensive coverage. Consumers who opt for cheaper, skimpier plans could end up with insufficient coverage in the event of illness or injury.

The new waiver guidance goes into effect immediately, meaning these criteria will be used by federal officials from now on, but Centers for Medicare & Medicaid Services and the Department of the Treasury are accepting public comment on the guidance for 60 days. 

The guidance is the latest in a series of changes to insurance market policies. These changes are generating much public debate about their potential impact on the marketplace and the availability of comprehensive, affordable coverage. The changes under discussion include health reimbursement arrangements, short-term limited duration plans, association health plans, and health care sharing ministries. 

HAP will closely monitor the impact of the Administration’s policy changes and work with the Department of Insurance and health care and consumer stakeholders to educate the public and provide affordable, quality access to health care for all Pennsylvanians.

If you have questions about the impact on insurance coverage in the state, please contact Jeff Bechtel, HAP’s senior vice president, health economics and policy. Questions about HAP’s federal advocacy efforts should be directed to Laura Stevens Kent, HAP’s vice president, federal advocacy.

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