Pennsylvania Health Care

                HOME                NEWS                GUEST BOOK               SITE MAP                ABOUT US


In 2014, the LAW requires everyone to have Health Insurance or pay a penalty.
Obamacare subsidies are for the needy and unemployed.  
For the rest of us, Insurance companies pay Obamacare 3.8%

OR compare numerous policies for your best rates, CLICK  


Three More Key Red States Could Still Sign Onto Obamacare


Virginia’s Republican-controlled statehouse is getting closer to expanding Medicaid under Obamacare, a top GOP legislator said Monday.

State Sen. Emmett Hanger, who is heading the panel that was created by the legislature to study Medicaid expansion, told the Roanoke Times that the group is “a little over halfway” toward a deal to expand the program’s eligibility to 133 percent of the federal poverty level in 2014, as prescribed in the Affordable Care Act.

Virginia and two other red states, Ohio and Michigan, are all still working to expand Medicaid next year.

Three more large conservative states signing onto that key provision of Obamacare would be a significant win for the White House. Since the U.S. Supreme Court made the Medicaid expansion optional last year, most GOP-led statehouses — with a few notable exceptions, such as Gov. Chris Christie in New Jersey and Gov. Jan Brewer in Arizona, who threatened to veto every bill that crossed her desk unless the legislature agreed to expansion — have turned down the deal.

In Virginia, the onus for expansion has shifted from Gov. Bob McDonnell (R) to the 10-member legislative panel. Earlier this year, the Republican-led General Assembly passed a bill that would allow for the expansion if the Medicaid program could be made more cost-efficient. The panel is considering various reforms, such as moving to more managed care, to make that happen.

A majority of the panel must vote for expansion for it to move forward. Public hearings are expected to begin this fall. About 400,000 low-income Virginians would be insured under the expansion, and the state would receive more than $20 billion in federal funding over the next decade.

In Ohio, Gov. John Kasich had endorsed Medicaid expansion earlier this year, but his plan was initially blocked by the GOP-led legislature, which cited cost concerns. A bill that included a spending cap for Medicaid in tandem with the expansion was then introduced last month by Democratic state Sen. Capri Carafo and taken up by a Senate subcommittee. That subcommittee received a report last week that the state would save $200 million in 2014 under the proposal, according to the Columbus Dispatch. If Ohio expanded Medicaid, rough 270,000 low-income residents would be insured. Kasich has yet to take a position on the new bill.

In Michigan, a state Senate committee unanimously passed a Medicaid expansion bill, along with two alternative proposals, at the end of the July. The GOP legislature is expected to take up the legislation when it reconvenes on Aug. 27. Republican Gov. Rick Snyder has said that he supports the expansion, and a bill has already cleared the House. More than 400,000 Michiganders would be insured if Medicaid were expanded.

The Congressional Budget Office estimated after the Court’s decision that three million people would be left uninsured because of states opting out of the expansion.

The states have their own incentive for scrambling to agree to the proposal before the year is out. The law requires the federal government to cover 100 percent of the expansion’s costs over the first three years (and never less than 90 percent after that). If states fail to expand in 2014, they miss one year of the 100 percent funding.

A common concern cited by GOP lawmakers is that the feds would renege on that promised funding, but those concerns have been largely dismissed by independent analysts. There is no precedent, they say, for the federal government to back out of such a significant funding commitment.

A handful of other red states, Indiana and Tennessee, were open to Medicaid expansion this year but ran out of time before their legislative session expired, according to the Kaiser Family Foundation. The Democratic New Hampshire legislature is also still considering an expansion bill; 60,000 would be insured under expansion in that state.

An expansion bill in the Republican-controlled Pennsylvania legislature passed the Senate, but died in the House before the legislature’s summer recess. Democrats, who were joined by some Republicans in the Senate, have pledged to bring the issue up again when the General Assembly reconvenes in September.

Republican Gov. Tom Corbett has said he would reject the expansion unless the Obama administration allowed the state to make significant changes to the program. Up to 800,000 low-income Pennsylvanians would be insured if the state agreed to the expansion.


Dylan Scott is a reporter for Talking Points Memo. He previously reported for Governing magazine in Washington, D.C., and the Las Vegas Sun. His work has been recognized with a 2013 American Society of Business Publication Editors award for Best Feature Series and a 2010 Associated Press Society of Ohio award for Best Investigative Reporting. He can be reached at dylan [at]

Pennsylvania ends Obamacare-related insurance program; critics paint it as proof of potential for broken funding promises


Pennsylvania has handed over to the federal government an Obamacare-related program that covers people whose medical needs are so great private insurers won't cover them.

Pennsylvania critics of Obamacare have seized the situation as proof the federal government can't be trusted to keep promises such as the one to fund most of the proposed expansion of Medicaid.

The program, called PA Fair Care, was created in 2010 as a bridge to 2014, when Obamacare will prevent insurers from denying coverage because of pre-existing conditions.

Congress allocated $5 billion in federal funds to pay for the so-called high-risk pool in Pennsylvania and other states, but costs ran higher than expected. Users of the government-subsidized coverage also pay premiums and co-pays.

Because of the funding shortfall, federal officials earlier this year informed Pennsylvania it must cap enrollment. Later, they gave the state the choice of keeping the program and taking responsibility for any costs above the $160 million allocated to Pennsylvania, or shifting enrollees to the federally-run version.

Pennsylvania Insurance Commissioner Michael Consedine objected to the changes, arguing Pennsylvania's program was well-run, and citing concern about disruptions in coverage for the 5,742 Pennsylvania residents in the program.

Consedine wrote to federal officials that, "In essence, you are asking the Commonwealth of Pennsylvania to either end the program or potentially fund at the state level a current federal program. We respectfully disagree with your two options."

However, Pennsylvania eventually agreed to shift enrollees to the federal program, joining 16 other states. Enrollees were supposed to receive new insurance cards by July 1, and begin using their new coverage as of that date.

Federal officials say the coverage will be similar, with annual deductibles prorated to reflect the six-month duration of the coverage. Pennsylvania residents will pay $241 per month, regardless of their age.

Because of the funding shortage, no new people will be accepted into the pool. In 2014, when the ban on pre-existing condition begins, high risk pool members are expected to switch to private coverage, and the program will end.

A spokesman for the U.S. Department of Health and Human Services on Wednesday refused to directly address claims from critics who say the high risk pool changes are proof of the possibility of other broken funding promises related to the Affordable Care Act, such as those pertaining to Medicaid expansion, which is under debate in Pennsylvania.

“Under the ACA, the Medicaid eligibility expansion is completely paid for by the Federal government in the first three years for the newly eligible population and the Federal government will cover at least 90 percent of these costs in the years thereafter," press secretary Fabien Levy said in an email.

Group Health Insurance in Pennsylvania
  • Eligible applicants may not be denied group coverage or be charged more due to health issues.
  • Employer may impose a waiting period on new employees.
  • Life changes relating to family or job loss may provide special opportunities for coverage.
  • Newborns and disabled children are guaranteed special coverage considerations.
  • In the case of a pre-existing condition, providers may review medical records for the six months prior to coverage.
  • An exclusion period of up to 12 months may apply to the pre-existing condition.
  • If continuous coverage has been maintained for over 63 days, creditable coverage applies to any exclusion period.

Small Business Health Insurance in Pennsylvania

  • Small businesses with fewer than 50 employees may not be denied small group coverage or cancelled based on health problems within the employee group.
  • Premiums may be higher based on health problems within the group.
  • Blue Cross Blue Shield premiums are based on modified community rating.

Self-Employed Health Insurance in Pennsylvania

  • The self-employed may not buy group health coverage.
  • Contact the Pennsylvania Department of Insurance for regulations concerning associations that are trade or business related and offer group health coverage.

Pennsylvania Department of Insurance 
1326 Strawberry Square 
Harrisburg, PA 17120
(717) 787-2317

Individual Health Insurance in Pennsylvania

  • There are different regulations for Blue Cross Blue Shield of Pennsylvania than for other private providers.
  • Blue Cross Blue Shield is required to issue a policy to all applicants.
  • The HIPAA eligible, must be offered two state approved policies.
  • Blue Cross Blue Shield may require a waiting period of up to 30 days for non-accident claims and six months for other elective claims.
  • For pre-existing conditions, an exclusion period of three years may apply unless the applicant is HIPAA eligible.
  • In a non-guaranteed policy, the provider may attach an elimination rider to the policy.
  • Pregnancy and genetic information may be classified as pre-existing conditions.
  • Community rating set the cost of a guaranteed issue policy.
  • Non-guaranteed policies have no limits on costs.
  • Blue Cross Blue Shield policies may not be cancelled based on sickness.
  • Other private insurers may deny coverage due to a health problem.
  • In the case of a pre-existing condition, private providers may attach an elimination rider to the policy or require an exclusion period of up to three years.
  • There is no creditable coverage for individual health plans.
  • There are no limits on premium costs.
  • Coverage may not be cancelled due to illness.
  • Contact the Pennsylvania Insurance Department for information that should be considered before purchasing health insurance coverage.

Pennsylvania Health Care Programs

Medicaid, Healthy Women Project, and Pennsylvania’s Children Health Insurance Program provide assistance to low income individuals.

Location Status of State Exchange Decision Medicaid Expansion Decision Executive Activity
Pennsylvania Default to Federal Exchange Opposes2