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On July 2nd, 2019, Governor Wolf signed Act 42, which created an opportunity for Pennsylvania to create a State reinsurance program to help moderate premiums in the Commonwealth's individual health insurance market and maintain and protect coverage gains in the Commonwealth.  Today, our uninsured rate of 5.5% is historically low. Pennsylvania's reinsurance program will be created under a Federal Section 1332 State Relief and Empowerment Waiver.

Section 1332 waiver empower states to pursue innovative programs and modify certain rules outlined in the Affordable Care Act (ACA) to tailor health care coverage options to meet the unique needs of their markets and their residents. State programs must meet four guardrails to take advantage of this waiver.  A waiver program must:  

  • provide coverage that is at least as comprehensive as ACA coverage;
  • provide coverage that is at least as affordable as ACA coverage;
  • provide coverage to a comparable number of state residents; and
  • not increase the federal deficit. 

The goal of Pennsylvania's proposed reinsurance program is to favorably impact premium rates in the year 2021 and beyond for Pennsylvanians purchasing health insurance coverage in the individual market. This is particularly important for those who do not qualify for federal tax credits. The program would work by using reinsurance funds to partially reimburse insurers for certain claims for higher-cost members in the individual market. This would allow the insurers to set lower premiums for all members than they otherwise would have without such reimbursement. Pennsylvania's reinsurance program will be "invisible" to consumers, who will continue to enroll in coverage and seek care under their policies in the same manner as always.  A consumer's experience and benefits will not be impacted.

To meet Federal requirements for a 1332 waiver to take effect in 2021, the Commonwealth of Pennsylvania is seeking public comment on a summary document of its draft Section 1332 State Relief and Empowerment Waiver Application. The application seeks to waive certain requirements of the ACA with the goal of expanding state's flexibility to implement the reinsurance program. A public comment period is required before the application is submitted to the Centers for Medicare and Medicaid Services (CMS), a division of the United States Department of Health and Human Services (HHS), and the Department of the Treasury.  The Insurance Department will be accepting public comments on Pennsylvania's 1332 Innovation Waiver beginning Friday, November 15, 2019 through Saturday, December 14, 2019.

How to comment:

Download the waiver application summary document to review.

You may comment in writing or in person.

Comments may be sent via email to or by mail to: 

 The PA Insurance Department 1332 Innovation Waiver
Attn:  David Buono
1326 Strawberry Square
Harrisburg, PA 17120

The Pennsylvania Insurance Department has also scheduled opportunities for you to learn more and to comment in person.  If you comment in person, you are encouraged to also submit comments in writing.

                December 3, 2019
                11:00 a.m.- 2:00 p.m.
                The Nittany Lion Inn
                200 W. Park Ave.
                State College, PA 16803

                December 5, 2019
                11:00 a.m.- 2:00 p.m.
                Keystone Building – Hearing Room 3
                400 North St.
                Harrisburg, PA 17120

Your feedback is important to us and to the success of this program. Written comments, whether submitted in addition to or instead of in-person comments, will be accepted through Saturday, December 14, 2019.