Pennsylvania Lawmakers Advance Sec. 1332 Waiver to Create a State-Based Health Insurance Exchange


On June 11, 2019, the Pennsylvania House passed H.R. 3, which would move the state off the federal health exchange platform and would instead create a state-based exchange platform that would be less expensive to operate. The federal exchange platform charges a user fee comprised of 3.5 percent of plan premiums, which in 2019, accounted for $94 million. This fee is much greater than what is required to run a state-based exchange, which is estimated to be around $30 million. Additionally, it is important for states to transition to state-based exchanges to ensure market stability in the event that the Affordable Care Act is invalidated.

H.R. 3 would enact a separate state fee that could be up to 3 percent of plan premiums, which would allow the state to devote $30 million towards the operation of a state-based exchange. The remainder of the funds, approximately $50 million, would go towards a state reinsurance fund that would reduce health care costs for consumers. This funding would be supplemented with $145 to $190 million in federal pass-through funds. H.R. 3 is supported by Pennsylvania Governor Tom Wolf and the Trump Administration, and it passed the Pennsylvania House with a 198-1 vote. The legislation is currently being considered by the Pennsylvania Senate.


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