Pennsylvania: Single-Payer Program
Upshot
Pennsylvania House Democrats introduced H.B. 2824, which would establish the Pennsylvania Health Care Plan (Plan), a statewide comprehensive health care system to provide coverage for all residents without any premium or cost sharing.
Goals of the plans would include controlling health care costs; achieving measurable improvements in health outcomes; promoting a culture of health awareness; and developing an integrated health care database to support health care planning and quality assurance.
The bill is not expected to advance this session, which concludes at the end of November. The lead sponsor acknowledged that the reintroduction of the bill was “largely symbolic.”
Background
Pennsylvania operates a state-based Marketplace. Thirteen insurers offered plans in 2022, with the same plans intending on offering coverage in 2023. Through legislation, the state transitioned to running its own Marketplace and implementing a reinsurance program in 2021. For the 2022 open enrollment period, 375,000 residents enrolled in individual Marketplace coverage.
Similar legislation has been introduced six times since 2005, with Rep. Pamela DeLissio (D) having introduced the bill twice. During a press conference on the reintroduction of the bill, Rep. DeLissio asserted that “health care is a right and not a privilege” and expressed support for a system which ensures that “citizens are not going financially bankrupt to stay healthy.” Rep. DeLissio also acknowledged that the bill is “largely symbolic” and hopes it “highlights that health care access must be equitable and affordable.”
Summary
The bill would establish the Pennsylvania Health Care Plan (Plan), a statewide comprehensive health care system to provide coverage for all residents without any premium or cost sharing. The following program aspects and administrative bodies are detailed below.
Establishment of the Pennsylvania Health Care Plan: The Plan would be required to provide coverage for residents of the Commonwealth that aims to:
Control health care costs;
Achieve measurable improvements in health outcomes;
Promote a culture of health awareness; and
Develop an integrated health care database to support health care planning and quality assurance.
Eligibility: The Plan would provide health care coverage for all state residents. The Pennsylvania Health Care Agency would establish rules for residency determinations.
Covered Services: The Pennsylvania Health Care Board would establish a single health care benefits package that mirrors the categories of services in the EHBs. Plan enrollees would not be subject to any copayments, deductibles, or any other fees for a service included in the covered services.
Provider Participation and Reimbursement: All licensed providers would be eligible to participate in the plan and reimbursement would be determined by the Board. The reimbursement rate would reflect compensation for services that fairly and fully reflect the skill, training, outcomes, operating overhead included in the costs of providing the service, capital costs of facilities and equipment, and cost of consumables and the expense of safely discarding medical waste, plus a reasonable profit sufficient to encourage talented individuals to enter the field.
The bill would allow participating providers to petition the Board for adjustments to reimbursement that they believe to be too low. After Agency review of the petition, the Board would determine the adequacy of the payment rate. Providers that are still dissatisfied with the rate could appeal the Board’s decision to the Commonwealth Court system.
Supplemental Health Insurance Coverage and Duplicate Coverage: Under the Plan, private health insurers would be permitted to offer coverage supplemental to the plan, but they could not provide duplicate coverage of covered services.
Rational Cost Containment: The Board would be required to screen and approve or disapprove private or public expenditures for new health care facilities and other capital investments that may lead to redundant and inefficient health care provider capacity.
Payroll Taxes: To finance the Plan, a 10 percent tax would be imposed on payroll amounts generated as a result of an employer conducting business activity within this Commonwealth and an additional 3 percent tax upon each class of income.
Plan Administration: The bill would establish several government agencies that would be responsible for the oversight and administration of the Plan. Additional details on each follow.
