The Facts of the Month
Here is something to mention when discussing health trends in the month ahead.
Between 1996 and 2023, the percentage of employers with 1,000 or more employees offering health benefits increased from 96.7% to 97.6%. Similarly, the percentage of employers with 100–999 employees offering health benefits increased from 92.7% to 95.6%. In contrast, among employers with 25–99 employees, the percentage offering health benefits decreased from 80.8% to 76.7%. It decreased from 64.9% to 51.8% among employers with 10–24 employees and also decreased from 34.2% to 22.5% among employers with fewer than 10 employees.
Source: Employee Benefits Research Institute, October 16, 2024 – https://www.ebri.org/docs/default-source/ebri-press-release/pr-1364-offerrates-16oct24.pdf?sfvrsn=2b3b042f_1
The Big Three
Each month PA-NABIP identifies three top public policy or legal developments that could impact our members and clients. Here are this month’s big three!
- The People Have Spoken
Final election results are in and one thing is very clear—change was the top priority of American voters on the national level. Interestingly, on the state level, things remain very much the same. On the national level, former President Donald Trump is returning to the White House, the GOP will enjoy control in both houses of Congress, and while a contentious and well litigated recount is in progress, it seems like longtime Pennsylvania Senator Bob Casey will be replaced by his Republic opponent, Dave McCormick in January. However, in Harrisburg, despite some tight races and a few new faces, the state Senate remains in Republican control, 28-22, and the Democratic party controls the House by one vote—the exact same margins as before the elections.
The Pennsylvania General Assembly wrapped up its current session and will return for its next two-year session on January 7, 2025. Before they left Harrisburg, the parties in both chambers held leadership elections. On the Senate side, the leadership will remain the same, with Senator Joseph Pittman (R-41) as the GOP majority leader, and Senator Jay Costa (D-43) as the minority leader. In the House, the Democrats will continue to be led by Speaker Joanna Clinton (D-141), but Representative Bryan Cutler (R-100) will be stepping down as the Republican leader and Representative Jesse Topper (R-78), a leadership newcomer, will replace him.
The two chambers have yet to decide who will chair the two committees with jurisdiction over health insurance. In the Senate, the likely candidate to chair the Banking and Insurance Committee is Senator Chris Gebhard (R-48). He was the Vice Chairman during this legislative session and owns a P&C and Life Insurance agency in Lebanon, PA. On the House side, it is not yet clear who will take control of the Insurance Committee in January. Official Committee Chairs will be announced in December.
- Pennie is Open For 2025 Business and Brokers Need to Complete Training by November 30th!
The Pennsylvania health insurance exchange, Pennie, began its 5th annual individual market open enrollment period on November 1, 2024. To start coverage on January 1, 2025, Pennsylvanians must enroll by December 15, 2024. In addition, current Pennie enrollees use the open enrollment period to review and possibly change plan options, as well make any updates to family size, income, and contact details to ensure the best plan match.
While anyone can purchase individual coverage through Pennie, subsidized coverage is only available to people who meet income criteria and are not offered coverage through their employer that meets affordability thresholds. Nine out of 10 Pennie customers qualify for on-the-spot tax credits and save more than $500 a month on average on their health plans.
Pennie works extensively through brokers to help people obtain and retain individual coverage through the marketplace. Brokers do need to be certified by Pennie, and the marketplace is actively training new brokers now. Brokers do need to complete recertification each year to be able to serve Pennie customers, and returning brokers will need to recertify by November 30, 2024. Pennie does not plan to issue any deadline exceptions for this open enrollment season, and if training is not completed by the deadline, affected brokers will be decertified by the exchange by December 31, 2024 and clients reassigned.
- Pennsylvania Insurance Department Releases Landmark Study on Health Insurer Provider Directories
The Pennsylvania Insurance Department (PID) just released the results of a study on the accuracy of health insurer provider directories amongst insurers that offer coverage in the Commonwealth’s ACA marketplace. This is the first time any state has collected and analyzed such data, and it shows persistent inaccuracies.
The federal Consolidated Appropriations Act of 2021 requires insurers to maintain up-to-date, accurate provider directories that list healthcare professionals, hospitals, and clinics in their networks. The impetus behind this requirement is that when directories are inaccurate, it affects people’s access to timely medical care.
The PID’s study included a survey of nearly 7,000 healthcare providers listed in Pennsylvania’s ACA Marketplace directories. It found significant inaccuracies that often persist over time and fall short of requirements under recent federal law. The most common inaccuracies involved outdated contact information and incorrect specialty listings, which can mislead patients and lead to care delays and unexpected charges. Findings include:
- Only 13 percent of the surveyed provider listings had accurate contact information;
- Up to 44 percent of providers were unreachable due to incorrect information; and
- Substantial differences in accuracy were noted between carriers, with some variations by provider specialty as well.
When announcing the results of the study, the PID stated it plans to work with insurance providers and healthcare stakeholders to improve matters for Commonwealth consumers. The department will initiate stakeholder outreach to gather input and develop solutions that reduce inaccuracies in provider directories, helping to ensure Pennsylvanians have reliable information about in-network healthcare options.
Check This Out!
If you want to expand your health policy knowledge beyond this newsletter, here is a resource to check out!
The Kaiser Family Foundation’s 26th annual Employer Health Benefits Survey examines trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices.