• GPAHU - Monthly State and Legislative Updates

    The Fact of the Month

    Here’s something to talk about when you are discussing plan design options with your clients. 

    People like to cite high insurance premiums and expensive prescription drug costs when talking about the rising cost of medical care in this country when really, hospitals are much more of a problem.  According to a new Rand study, hospital spending represents 44 percent of privately insured people's health expenses.  Another recent study published in the journal Health Affairs shows that between “2007–14 hospital prices grew substantially faster than physician prices. For inpatient care, hospital prices grew 42 percent, while physician prices grew 18 percent. Similarly, for hospital-based outpatient care, hospital prices grew 25 percent, while physician prices grew 6 percent.

    The Big Three

    Each month GPAHU identifies three top public policy or legal developments that could impact our members and their clients.  Here are this month’s big three!

    Pennsylvania Health Insurance Exchange Leadership Announced

    Earlier this month, the Wolf Administration announced the incoming leadership of the new Pennsylvania Health Insurance Exchange Authority. The Exchange Authority is the entity that will create, manage, and maintain Pennsylvania's new state-based health insurance marketplace. The Authority's Executive Director will be Zachary Sherman, who currently serves as the director of HealthSource Rhode Island.  The Administration revealed the members of the Authority's Board of Directors as well.  Appointments to the Exchange Authority's Advisory Council, which will include a representative appointed by the Pennsylvania Association of Health Underwriters will be forthcoming

    The next step is for the Senate to take up the legislation. Senators Mike Rounds (R-SD) and Martin Heinrich (D-NM) have sponsored a companion bill with 61 co-sponsors, including Pennsylvania Senator Robert Casey. It is essential that Pennsylvania's other Senator, Pat Toomey, knows about our organization's support for the full repeal of the excise tax. So please click here to send him a message by utilizing NAHU’s Operation Shout platform.

    Act 42, signed into law on July 2, 2019, requires the Commonwealth to set up this Authority and establish an online individual health insurance exchange marketplace operated by the state. The state-based exchange will allow consumers to enroll in coverage starting during open enrollment for 2021.  The new law also requires the state to create a state reinsurance pool to backstop high individual market claims.  The Commonwealth must apply for a federal Affordable Care Act (ACA) Section 1332 waiver to fund the program, and the Pennsylvania Department of Insurance will manage both the pool and that process.

    Act 42 specifies that the governor will appoint four voting Exchange members, and one voting member each will be appointed by the speaker of the house, the house minority leader, the senate pro tempore, and the senate minority leader.  In the future, all board appointments will be for a four-year term, but initially, terms are staggered.

    Gubernatorial Appointments:

    • Paula Sunshine, Independence Blue Cross
    • Sheryl Kashuba, UPMC Health Plan
    • Tia Whitaker, Pennsylvania Association of Community Health Centers
    • Antoinette Kraus, Pennsylvania Health Access Network

    Speaker of the House Appointment:

    • Mark Nave, Highmark

    House Minority Leader Appointment:

    • Jessica Brooks, Pittsburgh Business Group on Health

    Senate Pro Tempore Appointment:

    • Todd Shamash, Capital Blue Cross

    Senate Minority Leader Appointment:

    • Laval Miller-Wilson, Pennsylvania Health Law Project

    The Exchange Authority board also includes the agency heads from the departments of health, human services, and insurance. These are:

    • Dr. Rachel Levine, Department of Health, Secretary
    • Teresa Miller, Department of Human Services, Secretary
    • Jessica Altman, Pennsylvania Insurance Department, Commissioner 

    Surprise Billing Legislation – Moving in Harrisburg but Stalling in DC?

    One of our association’s top policy priorities is "surprise billing legislation." These measures protect people who go to an in-network healthcare facility but later receive an expensive medical bill from an out-of-network provider. Earlier this summer, it seemed like bills on this topic were moving quickly in both Harrisburg and Washington, DC. GPAHU legislative team members met with federal and state representatives in our area this summer to encourage expedient action. At the state level, that message seemed to get through, but Congress is another matter.

    In Harrisburg, the House Insurance Committee made surprise billing legislation its top fall priority.  They are holding stakeholder meetings to help advance this issue over the next few weeks.  PAHU is participating by providing comments on draft language and representation through our lobbying firm, the Bravo Group. One concern is that some lawmakers crafting the state-level language favor an arbitration approach.  This would be applied when providers object to being paid a median in-network rate for the services in question. PAHU and NAHU generally oppose this approach, as it is less efficient and can be more costly.

    In Washington, lawmakers could link one of the many pieces of surprise billing legislation under consideration to a must-pass revenue bill. Unfortunately, right now, that course of action is looking less than likely. During the August recess, provider and hospital groups, and the equity companies that fund them launched a massive advertising and grassroots campaign questioning the structure of the bills under consideration.  Those objecting to the legislation claim that insurers will set the price that is paid to providers, thereby lowering their revenue.  Another potential obstacle is partisan electoral politics.  Many high-ranking politicians on both sides of the aisle support surprise billing legislation, but just as many have raised concerns about potentially giving the other side a “win” in advance of a contentious election season. 

    GPAHU and PAHU will continue to work with our state and federal representatives on this issue.  As opportunities come up for our chapter to advance this cause, GPAHU will be sure to keep our members informed.  

    A New Premium Tax Finances Delaware's Reinsurance Pool

    The same legislation that created Pennsylvania's new state-based health insurance exchange also requires the Commonwealth to apply for a federal ACA Section 1332 waiver to create a state individual market reinsurance pool. Pennsylvania plans to fund its share of pool costs using fee money collected from the carriers who participate in the exchange.  However, Pennsylvania is not the only state in our area that is in the process of creating a state-wide reinsurance pool to backstop high individual market claims.  The state of Delaware was also recently approved to start one in 2020.  Unlike Pennsylvania, our neighbors to the south will fund their pool with a new state premium tax on all fully-insured health insurance products.

    The total cost of the Delaware reinsurance pool is projected to be almost $27 million.  The state anticipates that they will ultimately receive $20 million in pass-through ACA funding from the federal government to pay for most of the pool’s costs.  To pay for the pool claims initially, and to cover any shortfalls, the state established a new premium tax.  The tax will increase the price of all fully-insured health insurance coverage sold in the state in 2020 on forward.  However, once Delaware gets the pool up and running in 2020, projections show individual market health insurance premiums could be 14 percent lower than what they would have been without it.

    Delaware modeled its new tax on the federal fee on fully insured coverage known as the HIT Tax. In the past, Congress has suspended the HIT tax for a year at a time. So, Delaware law specifies that in any year the federal tax is suspended, then Delaware will assess each health insurance company for 2.75 percent of premium revenue. When the federal HIT tax is in place, the state tax amount will be 1 percent of premiums.  As of right now, the federal HIT tax is scheduled to be in effect again in 2020.  That means Delaware business and individual consumers of fully-insured coverage will pay an additional 1 percent in premiums to cover the cost of catastrophic claims next year.

    The other neighboring state with a reinsurance pool is New Jersey. Last year the Garden State used general revenue funds to pay for its share of pool costs. Once New Jersey begins to collect penalty fees from its state-specific individual mandate in 2020, they plan to direct the related revenue to the reinsurance pool.

    Check This Out!

    If you want to better understand how business leaders view healthcare and how it could influence your clients, check this out!

    The Pennsylvania Chamber of Commerce has a monthly podcast called All Business.  While the show is always informative, this month it is particularly relevant for GPAHU members.  PA Chamber of Commerce Insurance’s Chief Operating Officer, Brian Orsinger, gives his insights on where health insurance for businesses is going, and his vision for PA Chamber Insurance's continued and growing success.   Click here to listen to this month's episode.

Legislative Archives

Find your Rep 

Locate your Senators and Representative

ex: 1600 Pennsylvania Ave, Washington, DC 20500

Legislative Contacts


GovernorDTom WolfePAgovernor.pa.gov
Insurance CommissionerTeresa D. MillerPA
US SenateRPat ToomeyPAdaniel_brandt@toomey.senate.gov(202) 224-4254
US SenateDBob Casey Jr.PAGeoffrey_mock@casey.senate.gov(202) 224-6324
US RepresentativeDRobert Brady1stbrady.house.gov(202) 225-4731
US RepresentativeDDwight Evans2ndevans.house.gov(202) 225-4001
US RepresentativeRRyan Costello6thcostello.house.gov(202) 225-4315
US RepresentativeRPatrick Meehan7thmeehan.house.gov(202) 225-2011
US RepresentativeRBrian Fitzpatrick8thfitzpatrick.house.gov(202) 225-4276

Local Contacts

HouseRStephen Barrarh160sbarrar@pahousegop.comDELAWARE COUNTY
HouseRAlexander Charltonh165acharlton@pahousegop.comDELAWARE COUNTY
HouseDMargo Davidsonh164mdavidson@pahouse.netDELAWARE COUNTY
HouseDMaria Donatuccih185MDonatucci@pahouse.netDELAWARE COUNTY
SenateRThomas Killions009tkillion@pasen.govDELAWARE COUNTY
HouseDBrian Kirklandh159bkirkland@pahouse.netDELAWARE COUNTY
HouseDLeanne Krueger-Branekyh161lkrueger-braneky@pahouse.netDELAWARE COUNTY
SenateDDaylin Leachs017senatorleach@pasenate.comDELAWARE COUNTY
HouseDJoanna McClintonh191jmcclinton@pahouse.netDELAWARE COUNTY
SenateRThomas McGarrigles026tmcgarrigle@pasen.govDELAWARE COUNTY
HouseRNick Miccarellih162Nmiccare@pahousegop.comDELAWARE COUNTY
HouseRChristopher Quinnh168cquinn@pahousegop.comDELAWARE COUNTY
HouseRJames Santorah163jsantora@pahousegop.comDELAWARE COUNTY
HouseDGreg Vitalih166gvitali@pahouse.netDELAWARE COUNTY
SenateDAnthony Hardy Williamss008williams@pasenate.comDELAWARE COUNTY
HouseRStephen Barrarh160sbarrar@pahousegop.comCHESTER COUNTY
HouseDCarolyn Comittah156ccomitta@pahouse.netCHESTER COUNTY
HouseRBecky Corbinh155bcorbin@pahousegop.comCHESTER COUNTY
SenateDAndrew Dinnimans019andydinniman@pasenate.comCHESTER COUNTY
HouseRTim Hennesseyh026thenness@pahousegop.comCHESTER COUNTY
HouseRWarren Kampfh157wkampf@pahousegop.comCHESTER COUNTY
SenateRThomas Killions009tkillion@pasen.govCHESTER COUNTY
HouseRJohn Lawrenceh013jlawrenc@pahousegop.comCHESTER COUNTY
HouseRHarry Lewish074hlewis@pahousegop.comCHESTER COUNTY
SenateRThomas McGarrigles026tmcgarrigle@pasen.govCHESTER COUNTY
HouseRDuane Milneh167dmilne@pahousegop.comCHESTER COUNTY
SenateRJohn Raffertys044jrafferty@pasen.govCHESTER COUNTY
HouseREric Roeh158eroe@pahousegop.comCHESTER COUNTY
HouseDKevin Boyleh172RepKevinBoyle@pahouse.netMONTGOMERY COUNTY
HouseDMatt Bradfordh070mbradford@pahouse.netMONTGOMERY COUNTY
HouseDTim Briggsh149repbriggs@pahouse.netMONTGOMERY COUNTY
HouseRMichael Corrh150mcorr@pahousegop.comMONTGOMERY COUNTY
HouseDMary Jo Daleyh148repmaryjodaley@pahouse.netMONTGOMERY COUNTY
HouseDMadeleine Deanh153mdean@pahouse.netMONTGOMERY COUNTY
HouseDPamela DeLissioh194RepDeLissio@pahouse.netMONTGOMERY COUNTY
HouseRRobert Godshallh053rgodshal@pahousegop.comMONTGOMERY COUNTY
SenateRStewart Greenleafs012sgreenleaf@pasen.govMONTGOMERY COUNTY
HouseRKate M. Harperh061kharper@pahousegop.comMONTGOMERY COUNTY
SenateDArthur Haywoods004senatorhaywood@pasenate.comMONTGOMERY COUNTY
HouseRTim Hennesseyh026thenness@pahousegop.comMONTGOMERY COUNTY
SenateDVincent Hughess007hughes@pasenate.comMONTGOMERY COUNTY
HouseRWarren Kampfh157wkampf@pahousegop.comMONTGOMERY COUNTY
SenateDDaylin Leachs017senatorleach@pasenate.comMONTGOMERY COUNTY
HouseDStephen McCarterh154RepMcCarter@pahouse.netMONTGOMERY COUNTY
SenateRBob Menschs024bmensch@pasen.govMONTGOMERY COUNTY
HouseRThomas Murth152tmurt@pahousegop.comMONTGOMERY COUNTY
HouseRThomas Quigleyh146tquigley@pahousegop.comMONTGOMERY COUNTY
SenateRJohn Raffertys044jrafferty@pasen.govMONTGOMERY COUNTY
HouseRJustin Simmonsh131jsimmons@pahousegop.comMONTGOMERY COUNTY
HouseRTodd Stephensh151tstephen@pahousegop.comMONTGOMERY COUNTY
HouseRMarcy Toepelh147mtoepel@pahousegop.comMONTGOMERY COUNTY
HouseDGreg Vitalih166gvitali@pahouse.netMONTGOMERY COUNTY
HouseDKevin Boyleh172RepKevinBoyle@pahouse.netMONTGOMERY COUNTY
HouseDVanessa Lowery Brownh190vbrown@pahouse.netMONTGOMERY COUNTY
HouseDDonna Bullockh195dbullock@pahouse.netMONTGOMERY COUNTY
HouseDMorgan Cephash192mcephas@pahouse.netMONTGOMERY COUNTY
HouseDAngel Cruzh180acruz@pahouse.netMONTGOMERY COUNTY
HouseDJason Dawkinsh179jdawkins@pahouse.netMONTGOMERY COUNTY
HouseDPamela DeLissioh194RepDeLissio@pahouse.netMONTGOMERY COUNTY
HouseDMaria Donatuccih185MDonatucci@pahouse.netMONTGOMERY COUNTY
HouseDMichael Driscollh173repdriscoll@pahouse.netMONTGOMERY COUNTY
SenateDLawrence Farneses001farnese@pasenate.comMONTGOMERY COUNTY
HouseDIsabella Fitzgeraldh203ifitzgerald@pahouse.netMONTGOMERY COUNTY
HouseDJordan Harrish186jharris@pahouse.netMONTGOMERY COUNTY
SenateDArthur Haywoods004senatorhaywood@pasenate.comMONTGOMERY COUNTY
SenateDVincent Hughess007hughes@pasenate.comMONTGOMERY COUNTY
HouseDWilliam Kellerh184wkeller@pahouse.netMONTGOMERY COUNTY
HouseDStephen Kinseyh201skinsey@pahouse.netMONTGOMERY COUNTY
HouseDJoanna McClintonh191jmcclinton@pahouse.netMONTGOMERY COUNTY
HouseRThomas Murth152tmurt@pahousegop.comMONTGOMERY COUNTY
HouseDEd Neilsonh174eneilson@pahouse.netMONTGOMERY COUNTY
HouseDMichael O'Brienh175mobrien@pahouse.netMONTGOMERY COUNTY
HouseDChristopher Rabbh200crabb@pahouse.netMONTGOMERY COUNTY
HouseDJames Roebuck, Jr.h188jroebuck@pahouse.netMONTGOMERY COUNTY
SenateDJohn Sabatinas005jsabatina@pasenate.comMONTGOMERY COUNTY
HouseDBrian Simsh182bsims@pahouse.netMONTGOMERY COUNTY
HouseDJared Solomonh202jsolomon@pahouse.netMONTGOMERY COUNTY
SenateDSharif Streets003sstreet@pasenate.comMONTGOMERY COUNTY
SenateDChristine Tartagliones002tartaglione@pasenate.comMONTGOMERY COUNTY
HouseRJohn Taylorh177jtaylor@pahousegop.comMONTGOMERY COUNTY
HouseDW. Curtis Thomash181cthomas@pahouse.netMONTGOMERY COUNTY
HouseRMartina Whiteh170mwhite@pahousegop.comMONTGOMERY COUNTY
SenateDAnthony Hardy Williamss008williams@pasenate.comMONTGOMERY COUNTY
HouseDRosita Youngbloodh198ryoungbl@pahouse.netMONTGOMERY COUNTY
HouseDTina Davish141RepDavis@pahouse.netBUCKS COUNTY
HouseRGene DiGirolamoh018gdigirol@pahousegop.comBUCKS COUNTY
HouseRFrank Farryh142ffarry@pahousegop.comBUCKS COUNTY
HouseDJohn Gallowayh140jgallowa@pahouse.netBUCKS COUNTY
SenateRStewart Greenleafs012sgreenleaf@pasen.govBUCKS COUNTY
SenateRCharles McIlhinneys010cmcilhinney@pasen.govBUCKS COUNTY
SenateRBob Menschs024bmensch@pasen.govBUCKS COUNTY
HouseRBernie O'Neillh029boneill@pahousegop.comBUCKS COUNTY
HouseRScott Petrih178spetri@pahousegop.comBUCKS COUNTY
HouseRMarguerite Quinnh143mquinn@pahousegop.comBUCKS COUNTY
HouseRCraig Staatsh145cstaats@pahousegop.comBUCKS COUNTY
SenateRRobert M. Tomlinsons006rtomlinson@pasen.govBUCKS COUNTY
HouseDPerry Warrenh031pwarren@pahouse.netBUCKS COUNTY
HouseRKatharine Watsonh144kwatson@pahousegop.comBUCKS COUNTY

Other Resources

BenefitsPRO is a publication that has a close relationship with NAHU. They do a great job at staying on top of industry developments, including health care reform

PA Insurance Dept

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