Pa. online health insurance marketplace opens

Pennie, Pennsylvania’s official online health insurance marketplace, is now open to all state residents to apply, compare plans, and enroll in high-quality health coverage.  

The annual Open Enrollment Period is an opportunity for Pennsylvanians to take advantage of substantial savings on 2023 coverage created by the American Rescue Plan and extended by the Inflation Reduction Act. 

Nine out of 10 Pennie customers qualify for financial savings and thus are eligible for subsidized monthly premiums on their health insurance. Nearly 40% of Pennie customers pay less than $75 per month. Pennie helps keep costs down amid rising inflation, and Open Enrollment is an opportunity for Pennsylvanians to protect their health and wallets by getting the coverage and care they need. 

“Easy access to affordable quality health coverage for all Pennsylvanians who want it is the bedrock on which Pennie was founded. As we strive to maximize the number of insured Pennsylvanians, the goal isn’t just to have insurance but to have insurance someone can actually use,” Pennie Executive Director Zachary W. Sherman said in a statement. “For anyone not insured through their job, Medical Assistance, or Medicare, I encourage them to explore their options through Pennie to see how we can help lower monthly premiums on high-quality health coverage from the top insurance companies across the commonwealth.” 

Representatives from Pennie, the Pennsylvania Insurance Department (PID), and Pennsylvania Association of Community Health Centers (PACHC) celebrated the start of the Open Enrollment period recently at Sadler Health Center in Carlisle.  

Pennsylvania Acting Insurance Company Commissioner Michael Humphreys said the Open Enrollment period marks the premier time to explore options and shop to find a plan, even for those who have insurance. He added that quality, comprehensive health care coverage has never been more affordable or more within reach for Pennsylvanians. 

“The Insurance Department’s goal of increased competition in the Marketplace has resulted in more choices, and increased affordability for consumers across the commonwealth,” said Humphreys. “We encourage consumers to research and compare plans to find coverage that best fits their needs and provides robust benefits for themselves and their families.” 

A recent change in federal policy has improved the affordability of health insurance for family members with insurance through a spouse or parent’s work. In 2023, Pennsylvanians paying more than 9.2% of their household income for a family plan through a family member’s job apply through Pennie to receive premium savings to reduce their cost of coverage. Families previously locked out of receiving Affordable Care Act subsidies can apply or update their application to enroll and receive the savings. 

“Our network of Community Health Centers continues to play a key role in ensuring Pennsylvanians gain the security of health coverage and access to quality affordable care.  In-person, unbiased Certified Enrollment Assisters are available to help patients and customers wade through the complexity of applying for health insurance at many locations statewide,” said Tia Whitaker, Statewide Director of Outreach and Enrollment at the Pennsylvania Association of Community Health Centers. 

As the Inflation Reduction Act has helped to provide additional savings and lower costs of premiums making it easier to enroll in coverage, Whitaker advised those interested to find a local Community Health Center by visiting pachc.org. 

Pennie and PID encourage those seeking coverage to go to Pennie.com prior to Jan. 15 and enroll in one of the options available in their area. Pennie’s Open Enrollment Period extends to Jan. 15, 2023. The deadline for coverage starting Jan. 1 is Dec. 15. For those enrolling between Dec. 15-Jan. 16, coverage will start Feb. 1, 2023. 

Bradbury-Sullivan LGBT Center sues Trump over roll back of ACA’s anti-discrimination protections

Adrian Shanker, executive director of Bradbury-Sullivan LGBT Community Center – Stacy Wescoe


The Bradbury-Sullivan LGBT Community Center in Allentown has joined a group of other organizations around the country suing the Trump Administration over the U.S. Department of Health and Human Services action to remove LGBTQ people and other populations from the protections of Section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of sex and other bases.

This is not Bradbury-Sullivan LGBT Community Center’s first time suing the Trump administration. In 2019, Bradbury-Sullivan, represented by Lambda Legal, was a plaintiff in Santa Clara v. Azar, a move to block the Trump Administration’s Denial-of-Care Rule. In response to the lawsuit, a District Court vacated the rule in its entirety in November.

“While HHS’s health care discrimination rule cannot change the law, it creates chaos and confusion where there was once clarity about the right of everyone in our communities, and specifically transgender people, to receive health care free of discrimination,” said Omar Gonzalez-Pagan, senior attorney and health care strategist for Lambda Legal, which is handling the lawsuit along with Steptoe & Johnson LLP.

In 2016, the Obama administration finalized a rule implementing the nondiscrimination provisions of the Affordable Care Act—also known as Section 1557—that prohibit discrimination based on gender identity, transgender status, or sex stereotypes as forms of sex discrimination.

In May 2019 the Trump administration announced a proposed rule change designed to roll back these protections.

Last week HHS published the health care discrimination rule eliminating LGBTQ protections, which is scheduled to go into effect Aug. 18.

Adrian Shanker, executive director of the center, said even with the protections under Section 1557, his organization has had to advocate with health insurers for such things as continuing hormone therapy.

While in the case he was referring to he said they were able to get the insurer to reverse the decision and apologize to the member, further stripping away such protections would make it even more difficult for many marginalized groups to obtain the proper health care.

He noted that the U.S. Supreme Court ruled last week that sex discrimination policies include sexual orientation and gender identity, overruling the HHS action.

The lawsuit, Whitman-Walker Clinic v. HHS, is filed on behalf of Whitman-Walker Health, the [email protected] Coalition, Bradbury-Sullivan LGBT Community Center, the Los Angeles LGBT Center, GLMA: Health Professionals Advancing LGBTQ Equality, AGLP: The Association of LGBTQ Psychiatrists, and four individual doctors.


Laying off workers? Here’s how to avoid ACA fines

Employers who layoff or furlough their staff could be subject to fines through the Affordable Care Act if they fail to offer those employees health coverage.

The COVID-19 pandemic has left many businesses little choice but to cut down on staff, but choosing not to outright terminate an employee could leave you open to one of two penalties, according to Rob Glus, partner and consulting actuary at Harrisburg-based financial advisory firm Conrad Siegel.

The act, commonly referred to as Obamacare, stipulates that employers with 50 or more full-time equivalent employees must offer at least 95% of their employees affordable health care. To determine what employees are considered full time during any given year, Glus said that most employers look back at the number of hours each employee worked the previous year and apply that to the next.

“If there is a furlough period where I am laid off, I am still considered a full-time employee for that period unless that employer terminates me,” Glus said.

Because each employee was already documented as full time for the coming year, employers need to offer some level of health care to the employees they furlough or layoff or they will be susceptible to the act’s “sledgehammer” penalty. The sledgehammer penalty is given to employers who fail to cover 95% of their employees. Businesses that incur the penalty are subject to $2,570 in fines for each full-time worker.

“From the Affordable Care Act perspective, that person is still a full time employee,” Glus said. “If I don’t offer coverage, I have opened myself to an employer-mandate penalty. You have to be careful with how you offer coverage.”

Glus suggests offering furloughed or laid off employees coverage through COBRA, a federal law that allows employees to continue their health care benefits but at 100% of the cost.

Offering COBRA to employees brings along its own risk. If an employee declines to keep their benefits through COBRA and elects a subsidized policy in the ACA marketplace, the employer could receive a “tack-hammer” penalty of $3,860 for that employee.

“The offer of COBRA is considered to be an offer of coverage and you’ve protected yourself as an employer for that calendar year, but it does open you up to the tack-hammer, or affordability penalty, as there is a possibility that the offer of coverage you are providing would be considered unaffordable,” Glus said.

Taking on the risk of the tack-hammer penalty could be worth it for employers since paying for coverage is a guaranteed expense but allowing an employee to turn down COBRA only has the risk of a potential penalty, said Glus.

Health care, politics, and COVID-19

Long before the coronavirus paralyzed the country, healthcare was a top concern among most Pennsylvanians. And healthcare will remain a top issue through the crisis and well after the November national elections, according to experts who have been monitoring long-term trends.

Exactly how public opinions might shift will depend on the ways the state, national and local governments handle the current crisis.

“Healthcare traditionally has been reported as the most important issue for Americans,” said G. Terry Madonna, director of the Center for Politics and Public Affairs, professor of public affairs, and director of the Franklin and Marshall College Poll. “What we don’t know is, if at the end of the day, do the values shift, do the opinions shift toward more government control? We have to see how it plays out,” he said.

Going into April, Bernie Sanders remained in the race, running on a platform of “Medicare for all,” a stance that was consistently attacked by more moderate candidates, such as South Bend, Indiana Mayor Pete Buttigieg and Sen. Amy Klobuchar of Minnesota before they dropped out of the Democratic primaries. They argued that national health care would be too expensive, especially considering that most Americans want to keep their private insurance. Joe Biden continued his support of the Affordable Care Act, which was the signature legislation of President Barack Obama. Biden, who strongly lobbied for the ACA as Obama’s vice president, has argued for improvements to the system, while encouraging an expansion of Medicare and improvements for private insurance.

As for Trump, he succeeded in getting rid of the ACA’s individual mandate, which required people to get insurance or pay a penalty. Until it was shed, the mandate led many people to pay the penalty because it was less expensive than insurance, which continued to go up under the ACA. Trump also has been fighting the ACA in federal courts, while maintaining that any replacement plan must include covering pre-existing conditions.

Madonna and others said the stances of Sanders, Biden and Trump might hold through the election but the coronavirus has been such a disruption that public opinion could shift, forcing all elected officials to re-think their positions. For example, if the federal government handles the crisis expertly, more citizens might gain confidence that it could handle a national health plan. However, the opposite could happen just as easily, Madonna said.

Gene Barr, president and CEO of the PA Chamber of Business and Industry, noted that Trump often has made public comments that support traditionally Democratic positions, such as controlling the prices of prescription drugs. However, if the pharmaceutical companies step up during the crisis and find a cure for the virus quickly, that could back the argument of why the drug companies need their profits to test new drugs and bring them to market, Barr said.

“It is far too early to know how Covid-19 will change people’s perspectives,” Barr said in late March.

In addition to limited constraints on drug companies, the state chamber has supported healthcare plans that would expand Association Health Plans, which give businesses opportunities to pool resources to barter for better prices from health insurance companies. It also backs stronger liability protections for healthcare providers.

“We think the private sector works well, and we need to keep it,” Barr said.

He agrees with Trump and the Democrats that any path forward must include protections for pre-existing conditions. However, assurances must be put in place so that people don’t drop insurance only to add it when they get sick, then drop it again when they get better. An assumption behind the ACA was that it would lower insurance costs because it would increase the pool of healthy young adults who would buy insurance, he and others pointed out. 

“We need to find a system that works but that calls for individual responsibility,” Barr said.

Christopher P. Borick, professor of political science and director of the Muhlenberg College Institute of Public Opinion, noted that Pennsylvania residents increasingly support more government involvement in healthcare. The college conducted its annual healthcare poll in early March. That timing was coincidental to the coronavirus crisis but before widespread social distancing.

The survey showed that Pennsylvanians increasingly think the federal government is responsible for ensuring Americans have healthcare coverage — nearly 6 in 10 Pennsylvanians or 59 percent of those polled.

 “This is an increase of 5% since 2019, when 54% of Pennsylvanians maintained this view,” the report said.

Studying trends

Borick agreed that the virus will have long-lasting societal and political ramifications but that more people have been leaning toward increased government involvement for years. 

“We already had been seeing movement in terms of government involvement,” he said in late March, as the results of the poll were being prepared for public release. For example, plans that would allow people to buy into Medicare would be popular.

The details of such Medicare buy-in plans will make the difference as to whether they gain traction, said Robert Glus, a partner and consulting actuary for Conrad Siegel, a benefits management company based in Harrisburg. Glus gave a presentation early in the year to the Central Penn Business Group on Health, a Lancaster-based group that helps businesses wade through healthcare issues to improve quality and costs. The presentation included overviews of how the national candidates’ platforms compare. While the idea of expanding Medicare is popular, people often become concerned when they see the potential costs.

Ideas require careful analysis because, if proposals don’t offer a level playing field with private insurance, such plans might be just a way to eventually steer care into a nationalized system years later. However, if plans offer fair competition and allow more people to become insured by buying into the Medicare system, that might be something that could gain wider support.

“How you would implement it is going to be important,” Glus said.

He pointed out that he didn’t provide the group with an overview of Republican proposals because detailed plans don’t exist. Trump has talked about controlling drug costs and ensuring pre-existing conditions are covered, but the Republicans don’t have any “overarching plans,” Glus said.

“I call it nibbling around the edges,” he added.

Borick said Trump can act like a populist — as seen by his statements about controlling the costs of prescription drugs — which could make him amenable to plans that expand government involvement. That especially could be true if the federal government handles the crisis well and if the states demonstrate that they stepped up. Trump also hasn’t shied away from spending big when he wants to, Borick said.

“If re-elected, would he go for some sort of big-ticket expansion of government investment?” Borick asked rhetorically. “If they handle it well, and it is seen as a success, it might give everyone some confidence that government could expand its role.”

But Borick and others cautioned that a lot of “ifs” remained as the reaction to the virus plays out.

Politicians, journalists and policy experts react to a crisis differently than most average citizens, said Daniel J. Hopkins, a professor in the department of political science at the University of Pennsylvania. In the height of a crisis, many people seek solutions and ideas that might be a shift from traditional ways of thinking. However, Hopkins said, studies suggest that severe shifts among average people are not long-lasting. He cautioned that, depending on when the virus crisis ends, a lot of people likely will revert to their previous corners of the debate, which would include a reluctance to give up their private insurance for a national plan.

After a crisis, “the public is less likely to draw broader ideological conclusions,” he said. “When faced with some new event, oftentimes the public goes to its greatest hits album.”

Diane Hess, executive director of the Central Penn Business Group on Health, said her group is teaming up with other agencies to track how the virus is handled. Hess, who attended the presentation given by Glus, agreed that the Republicans and Trump don’t provide detailed alternatives to the ACA. They need to come up with a plan that can be compared to it.

“And then we can decide what we like and don’t like,” Hess added. 

Until then, Democrats will continue to push to improve the ACA. However, many citizens are skeptical about expanding it or Medicare because early promises — such as lower costs or that patients would be able to keep their doctors — were not kept, she said.

“I think there is some distrust in the eyes of the people,” Hess said, adding that the government response to coronavirus might help steer future conversations about healthcare improvements. “We are just too early in the process to know exactly what is going on.”

The overall issue isn’t going away, Hess pointed out.

“Healthcare will continue to be the No. 1 issue,” she said. “… We really need to go back to our roots. How can we improve access and cost?”

Sen. Bob Casey warns consumers about confusing health insurance ads

It’s open enrollment season for health insurance in America, which runs from Nov. 1 through Dec. 15.  As health care consumers are shopping for health plans, U.S. Sen. Bob Casey (D-PA) is warning the public not to confuse the insurance plans featured in some online advertisements with the health insurance that can be purchased on the federal HealthCare.gov. website.

Sen. Casey addresses the crowd at Casa Guadalupe in Allentown – submitted

The sponsored advertisements can be confusing for health care consumers, Casey said at a press conference on Nov. 18 at Casa Guadalupe, a social services center in Allentown.

Teresa Miller, secretary of the Pennsylvania Department of Human Services, joined Casey in expressing concern about misleading health insurance ads at the event.

Casey stated that the advertised short-term limited duration insurance plans (STLD), which are permitted to exclude those with pre-existing conditions, are not able to be purchased through HealthCare.gov, but can be purchased through other websites, agents and brokers.

Under current regulations, consumer protections like limits on out-of-pocket expenses do not apply to the STLD plans. STLD plans also do not need to meet the minimum essential coverage standard under the Affordable Care Act.

Casey urged consumers to be aware that advertisements for STLD plans often use “HealthCare.gov” in the website title, despite having no affiliation with Healthcare.gov, making it difficult for individuals to differentiate between paid advertisements and search results.