Advocates Explain New Health Care Options for Pennsylvanians Under Affordable Care Act

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HARRISBURG, PA (September 30, 2013) — Beginning Tuesday, Pennsylvanians who are working but lack health insurance will be able to shop for and compare options for affordable coverage on a new competitive Health Insurance Marketplace established by the federal health care law.

Tuesday marks the first day of a six-month open enrollment period during which uninsured Pennsylvanians and their families will be able to buy coverage with the help of federal tax subsidies on the new Marketplace. It is the latest provision of the Affordable Care Act to take effect.

Advocates and health care providers explained during a State Capitol press conference today that the new Marketplace will open the door to health coverage for hundreds of thousands of hardworking Pennsylvanians who will be able to see a doctor for the first time in years.

“This is the beginning of a journey toward meeting the health care needs of individuals and families across the nation,” said Sharon Ward, Director of the Pennsylvania Budget and Policy Center. “The Marketplace will give Pennsylvanians valuable new options and allow them to decide which coverage best fits their family’s needs.”

Watch a 5-minute recap of the press conference.

The Marketplace is designed for those who don’t have health coverage through their employers and are not eligible for Medicare, Medicaid, or CHIP. Those with employer-offered coverage can keep it.

Insurance companies participating in the Marketplace will compete to provide the best product at the best price to consumers seeking health coverage. Tough rules will ensure that every package sold on the Marketplace covers the basics, like annual checkups and preventive medicine.

Susan Mull, a substitute teacher from Lancaster
Susan Mull, a substitute teacher from Lancaster, has a pre-existing condition and has been uninsured for 13 years. The Affordable Care Act opens new options for her and hundreds of thousands of other Pennsylvanians.

Tax credits will make premiums even more affordable for low- and moderate-income families. One study found more than half of those who buy in a marketplace will pay less than $100 per person per month.

Those seeking insurance can go to to apply in Pennsylvania. An online form will ask applicants questions about their income and other factors, allow them to compare coverage options and prices, and calculate how much in federal tax subsidies are available to help them pay for the costs. The tax subsidy benefits are applied to immediately lower the premium. People needing assistance can call 1-800-318-2596.

“Pennsylvania hospitals and health systems across the state stand ready to support consumers in this important enrollment process,” Pam Clarke, Vice President of Finance and Managed Care for The Hospital & HealthSystem Association of Pennsylvania, said at the press conference. “We are committed to ensuring that more Pennsylvanians have access to affordable, timely, quality health care, which is so critical to their quality of life.

“The hospital community and HAP believe the Health Insurance Marketplace will be successful in enrolling many Pennsylvanians in viable health plans. As cornerstones of their communities, hospitals have developed important relationships with patients, consumers, and community leaders, making them an integral resource in the marketplace initiative.”

The Affordable Care Act will also make health care coverage more secure by ensuring that working families cannot be denied coverage due to a pre-existing condition, or lose their coverage or be forced into bankruptcy when someone gets sick. Lifetime caps on insurance benefits will also be a thing of the past.

Over 3 million young adults are also benefitting from the Affordable Care Act by being able to stay on their parent’s plans.

Susan Mull of Lancaster told her story of living with a pre-existing condition for 13 years without health insurance because her husband is self employed and she works part-time as a substitute teacher. Individual coverage was unaffordable, she said.

“Health care is a human right," Mull said. "I cannot say it in any simpler way. … I hope you understand how powerful, how life changing this will be for people who have thought they would die without ever having health insurance again.”

“Shopping on the new health Marketplace will help Pennsylvanians live longer and healthier than ever before,” said Becca Raley, Executive Director of the Carlisle Area Health & Wellness Foundation.

“Like many organizations across the commonwealth, Carlisle Area Health & Wellness Foundation is working to ensure that community members receive accurate information about how to enroll for affordable care. At the local level, we’re launching a ground campaign through partnerships with our local libraries, churches and nonprofits to ensure that community groups are well prepared to guide people to the right information.”

Ray Landis, Advocacy Manager for AARP Pennsylvania, said: “The beginning of the health exchange open enrollment process is especially important for those between the ages of 50 and 64 who are not yet eligible for Medicare but who have had the most difficult time finding affordable health insurance because of the chronic health conditions that affect many Pennsylvania in this age group.”

Seniors who receive Medicare will be able to keep it and do not need to go through the new Marketplace for coverage. Under the Affordable Care Act, Medicare will cover more prescription drug costs as the new law will close the donut hole.

The new law also improves health care for women and children, added Patricia Fonzi, Vice President of Customer Service and Relationship Management, Family Health Council of Central PA.

“No longer will insurers be able to charge women more than men for the same coverage or deny coverage for maternity care,” Fonzi said.

Pennsylvanians seeking coverage must shop for it on the federally-established Marketplace in order to qualify for tax subsidies, Ward noted. Insurance plans sold on online “marketplaces” or “exchanges” not authorized by the health law may confuse people.

Pennsylvanians should go to to apply through the state’s federally-established Marketplace and to find additional information and help. Open enrollment runs from Oct. 1, 2013 through March 31, 2014. Applicants must apply by Dec. 15 to begin receiving coverage Jan. 1. People needing assistance can call 1-800-318-2596.