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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 empowers states to pursue innovative programs and modify certain rules outlined in the Affordable Care Act (ACA) to tailor healthcare 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 the 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.  

Download the waiver application summary document to review.

The Insurance Department held meetings for public comment at 200 W. Park Ave. in State College on Tuesday, December 3, 2019, and at 400 North St. Harrisburg on Thursday, December 5,  2019.  The written public comment period ended at 11:59 pm Saturday, December 14, 2019.

The following written comments were submitted electronically to the Insurance Department: