Insurance Commissioner Teresa Miller Thursday issued a response to Majority Leader Kevin McCarthy outlining Pennsylvania's experience with the Affordable Care Act, strengths of the law, and areas for improvement.
In December 2016, Majority Leader McCarthy and other members of U.S. House of Representatives' Republican leadership requested input and recommendations from governors and insurance commissioners on potential health care reforms under the next administration.
"It is important to first establish the baseline from which any changes will be made. Today, more people in Pennsylvania and across the country have health insurance than ever before," said Commissioner Miller. "In our Commonwealth, more than 1.1 million people are enrolled in the programs established by the Affordable Care Act, many of whom are able to access and afford coverage for the first time. This includes the 670,000 Pennsylvanians who receive health insurance through Medicaid expansion, almost 63,000 of whom were able to access drug and alcohol treatment that is critical to helping patients' recovery as we face an unprecedented public health crisis in the opioid and heroin epidemic."
Commissioner Miller also highlighted the law's ban on lifetime limits and prohibition on exclusions due to pre-existing conditions.
These crucial consumer protection aspects of the Affordable Care Act ensure that consumers are able to access robust and comprehensive health insurance coverage that does not put individuals with chronic or catastrophic conditions in dangerous financial positions.
Access to free preventive services, which is also included in the law, allows consumers to access regular doctors' visits and screenings that can help manage and identify potential health issues before they become more advanced and costly.
A recent study by the National Center for Health Statistics also found that that the number of people whose families currently struggle to pay medicals bills has declined by 22 percent or by 13 million people over the last five years.
"The ACA is not perfect," said Commissioner Miller. "But as we talk about changes to this baseline, I ask that you ensure they result in progress not regress."
In her response, Commissioner Miller indicated that while she supports providing states more flexibility, it is imperative Congress allow states to maintain much of the existing framework created by the federal health insurance law as part of that flexibility.
She highlighted a need for stability and predictability in order to help Pennsylvania's individual market and others around the country.
Commissioner Miller offered the following suggestions, among others, as potential avenues of promoting marketplace stability and increasing flexibility for state regulators:
-- Maintain the balance created by the "three-legged stool" provisions of ACA (individual mandate, prohibition on excluding individuals with pre-existing conditions, and availability of premium tax subsidies and cost-sharing reductions) to avoid collapse of individual markets around the country;
-- Support states in efforts to increase competition in their markets rather than forcing states to allow insurance products approved by other states to be sold in theirs, which has the potential to undermine state-based regulation and consumer protections;
-- Increase enforcement of rules governing special enrollment periods;
-- Make complete risk corridor payments owed to insurers;
-- Avoid high-risk pools that could be cost-prohibitive to states due to high administrative and claims costs, or at least allow states flexibility to pursue alternative mechanisms to address the impact of individuals with significant health needs on a state's risk pool;
-- Limit year-to-year changes in federal rules that govern state individual markets to create long-term certainty for insurance companies; and
-- Consider timing and giving proper notice to insurance companies if changes are made to avoid market disturbances in the interim.
Commissioner Miller also stressed the importance of addressing rising health care costs in order to improve health insurance affordability long-term.
"Insurance coverage is expensive because the underlying costs of health care are expensive. The average per capita health care spending in the United States is almost $10,000, far more than the average American can afford to pay for care," said Commissioner Miller. "If we want to improve the affordability of insurance products, we need to tackle the root causes."
Commissioner Miller identified curbing prescription drug costs, incentivizing value over volume when accessing and paying for care, and increasing transparency of health care costs to help consumers make empowered buying decisions as ways that could help rein in health care spending.