Insurers could soon be facing a new requirement if they want to sell policies through Pennsylvania’s subsidized health insurance marketplace, known as Pennie.
The operator of the marketplace is proposing a regulation that would require insurers to become accredited in health equity.
The Pennsylvania Health Insurance Exchange Authority argues that health equity is a “well-recognized accreditation standard” used in other states, and a standard required of managed care organizations in Pennsylvania’s Medicaid program, which covers medical care for low-income residents.
The accreditation could also help expand access to insurance among the roughly 5.4% of state residents who remain without coverage, the authority added.
Further the authority says, the standard helps insurers “better meet the cultural and linguistic needs of their customers and build provider networks that are responsive to their specific healthcare needs.”
About 435,000 state residents are covered through Pennie, which is authorized under the federal Affordable Care Act.
Insurers selling plans through Pennie include Capital Blue Cross, Highmark and UPMC Health Plan.
Who’s pushing back: State Sen. John DiSanto, a Dauphin County Republican, and state Rep. Bryan Cutler, a Lancaster County Republican and leader of his party in the state House. They have filed comments skeptical of the health-equity proposal.
In comments on the proposal filed last month, DiSanto questioned the need for additional requirements on insurers and asked the authority for clearer evidence of any problems the proposal aims to address.
“Overall, this regulation raises concerns for me that insurers that are currently equal opportunity employers with non-discrimination policies consistent with applicable state and federal laws somehow aren’t meeting Pennie’s expectations,” DiSanto wrote, suggesting that Pennie was straying from its original purpose of helping state residents access low-cost health insurance.
Cutler raised similar questions and also wondered whether a new mandate would increase healthcare costs.
In a statement, the marketplace authority noted that its board — which includes lawmakers from both parties — approved implementation of an accreditation requirement.
“Pennie’s goal is always to ensure every Pennsylvania has access to affordable health care coverage, and this regulation would help us pursue that goal,” the authority said.
What’s next: Public comments on the regulatory proposal are due June 24.
The Independent Regulatory Review Commission, an independent state panel, is slated to issue its own comments a month later.
DiSanto, meanwhile, tied the proposal to Gov. Josh Shapiro’s $50 million plan to make insurance policies on Pennie more affordable, with the senator saying he was “hesitant” to support the new spending in light of Pennie’s regulatory moves.
“I remain hopeful that we can reach consensus on how to proceed with these matters and look forward to receiving your response,” DiSanto wrote.
Pennie said it looked forward to considering the comments on its proposal and responding to them through the rulemaking process.