Health Care Reform Advisory Committee Report Shows Broad Agreement on How to Implement National Law in Pennsylvania

Recommendations will ensure health care reform implementation puts the interests of taxpayers, small businesses and working families first

HARRISBURG, Pa., Jan. 17, 2011 /PRNewswire-USNewswire/ -- Governor Edward G. Rendell today accepted a report from a non-partisan advisory committee that lays out a plan for Pennsylvania's implementation of national health care reform so that taxpayers, working families and small businesses get the greatest benefit from expanding access to health care and bringing costs under control.

"The national health care reform law will provide access to affordable quality health care for families and businesses who currently have health insurance and also for those who do not," Governor Rendell said. "While the national law creates the framework for these reforms, much of the implementation is left up to the states. That is why I asked a broad group with diverse perspectives to help put together a strategy to make the law work for Pennsylvania."

In March 2010, Congress enacted the Patient Protection and Affordable Care Act (ACA), the most sweeping transformation of the health care system since Medicare and Medicaid were established 45 years ago. The law's implementation schedule is ambitious, and in June 2010, Governor Rendell signed an Executive Order creating the Commonwealth Health Care Reform Implementation Advisory Committee to advise the state on policies and program changes that meet Pennsylvania's unique needs.

The 47-member, non-partisan committee was chaired by Rosemarie B. Greco, the Governor's senior adviser on health care issues and former director of the Governor's Office of Health Care Reform. The panel included consumers, small businesses, labor groups, advocacy organizations, health care providers, insurance companies, hospitals, experts, and members of the General Assembly and the Executive Branch.

"This group did an extraordinary amount of work in a short period of time and perhaps what is most impressive was the enormous consensus among these diverse stakeholders on how to implement the health care reform law in Pennsylvania," Greco said. "Of nearly 90 recommendations in the report, all but three represent the unanimous opinion of the entire Advisory Committee."

The report contains findings and recommendations that are intended to serve as a blueprint for implementation of the ACA. The recommendations center on the creation of a health insurance exchange – which is a marketplace for buying health insurance that provides one-stop shopping for individuals and small businesses to compare rates, benefits and quality among plans under the new law; increasing access and enrollment; and implementing other health care reforms to improve health care quality and contain costs.

The report will be made available to the public, shared with the Governor-elect's transition team, and transmitted to the General Assembly.

The full report can be accessed at: http://www.portal.state.pa.us/portal/server.pt/document/1036742/health_care_reform_implementation_pdf. The appendices can be found at: http://www.portal.state.pa.us/portal/server.pt/document/1036743/hcr_appendices_pdf.

A summary of major recommendations follows.

Health Insurance Exchange

Challenge: The Commonwealth must establish a state-based Health Insurance Exchange by mid-2013 or the federal government will implement this component of ACA in Pennsylvania. If Pennsylvania elects to establish an exchange, there are a multitude of policy, information technology, enrollment, and synchronization issues that will need to be addressed. The Exchange Subcommittee focused on broad policy issues associated with whether and how the state should operate a health insurance exchange.

Recommendations: Consensus was reached on many aspects of the exchange. The Advisory Committee recommends that the state create an exchange and that it have a consumer-oriented mission. While no consensus was reached, the majority felt that this exchange should be established as an independent public agency or authority that is governed by a diverse board with clear prohibitions on conflicts of interest and with a strong management team. Additionally, it was agreed that consumers should be able to access insurance inside and outside the exchange and that plans that are offered in both would have the same premiums and be subject to consistent Insurance Department rate review. Lastly, while consensus was not reached, the majority supports an exchange that has authority to negotiate as an active purchaser to drive the best value for employers and individuals.

"The decisions Pennsylvania makes on how to create the health insurance exchange will have a major impact on whether the law meets its potential for improving health care affordability and quality for small businesses and working families," said Ann Torregrossa, the director of the Governor's Office of Health Care Reform. "The Advisory Committee worked hard to create a vision for an exchange whose top priority is the needs of the health care consumer."

Access and Enrollment

Challenge: State-operated exchanges must meet the needs of a wide variety of customers, from individuals who qualify for premium subsidies to small businesses seeking to purchase insurance for their employees and applying for tax credits. States will be expected to streamline and simplify enrollment processes, maintain state-of-the-art web portals, and provide additional assistance to those in need. The Access and Enrollment Subcommittee focused its work on formulating a vision for how the exchange should support consumers – both individuals and businesses.

Recommendations: The Advisory Committee reached complete consensus on the subcommittee's findings and recommendations. Major recommendations include creation of a robust, state-of-the art web portal for individuals and businesses to provide clear and understandable information about coverage available through the exchange and a full-service customer service call center to assist consumers. Also, the Advisory Committee recommends the exchange have a single application for all insurance programs with integrated eligibility processes. Continuity of care was of particular concern for low-income individuals who may be transitioning in and out of Medicaid into subsidized coverage. For example, it was recommended that Medicaid and non-Medicaid plans create partnerships to assure access to the same providers. In this context, the state should carefully examine the Basic Health Plan option which may save the state money while better coordinating benefits for this gap population. Lastly, the Advisory Committee recommends the Commonwealth take full advantage of opportunities to support long-term care reform.

"The Access and Enrollment Subcommittee members committed themselves to lengthy and spirited discussion and debate regarding the many factors that we thought would best address the diverse needs and interests of Pennsylvania residents," said subcommittee co-chair John Lovelace, vice president for children's health insurance & Medicare special needs plan at UPMC Health Plan. "For health reform to by meaningful and effective, consumers must be able to make informed choice."

Other Critical Reforms

Challenge: Expansion of health insurance coverage should be accompanied by measures to improve the ability of the health care system to provide quality care in the most effective and cost-efficient manner possible. In addition to making changes in Medicaid and Medicare that will improve quality and reduce costs, the ACA provides many tools that states can use to make progress on this overarching goal. The Other Critical Reforms Subcommittee identified critical areas of focus for improving quality, reducing costs and assuring access to services for the newly insured.

Recommendations: The Advisory Committee also reached complete consensus on the subcommittee's report. Major recommendations for the incoming administration include reforming how the state pays for health care (e.g., PEBTF, Medicaid, CHIP, adultBasic, Corrections) so that providers are paid based on the efficient use of resources while providing high quality care – instead of simply for the number of procedures they perform or patients they treat. In addition, the report recommends continuation of the Chronic Care Initiative, which is proven to save money and improve care and which currently includes 900 primary care practitioners which serve more than 1.4 million patients, so that it is the norm for practice in the Commonwealth. The report also recommends the state provide additional support for safety net providers and provide better supports for consumers to make informed decisions about options for treatment and take a more active role in their care. Finally, the report recommends measures for taking the state's efforts to reduce medical errors to the next level, to improve end-of-life care and to ensure the workforce can meet emerging health needs.

"The unanimous agreement reflected in this multi-stakeholder report suggests the value of these recommendations," said Karen Wolk Feinstein, president and chief executive officer of the Pittsburgh Regional Health Initiative and co-chair of the Other Critical Reforms Subcommittee. "I think it's fair to say that all participants stand ready to assist the new administration in implementation."

Media contact: Gary Tuma, 717-579-6667

SOURCE Pennsylvania Office of the Governor