1Establishing the Health Insurance Exchange Task Force; setting
2limits on the expansion of Medicaid coverage; and imposing
3powers and duties on the Insurance Commissioner and the
4Secretary of Public Welfare.

5The General Assembly of the Commonwealth of Pennsylvania
6hereby enacts as follows:

7Section 1.  Short title.

8This act shall be known and may be cited as the Health
9Insurance Exchange Act.

10Section 2.  Definitions.

11The following words and phrases when used in this act shall
12have the meanings given to them in this section unless the
13context clearly indicates otherwise:

14"Affordable Care Act."  The Patient Protection and Affordable
15Care Act (Public Law 111-148, 124 Stat. 119) as amended by the
16Health Care and Education Reconciliation Act of 2010 (Public Law
17111-152, 124 Stat. 1029).

18"Commissioner."  The Insurance Commissioner of the

1Commonwealth.

2"Federally facilitated exchange."  An exchange platform that
3is established by the Federal Government in compliance with the
4Patient Protection and Affordable Care Act (Public Law 111-148,
5124 Stat. 119).

6"Secretary."  The Secretary of Public Welfare of the
7Commonwealth.

8"Task force."  The Health Insurance Exchange Task Force
9established under this act.

10Section 3.  Limitation on expansion of Medicaid.

11Expansion of access to Medicaid to the population set by a
12fixed percentage of the Federal poverty level, as proposed in
13the Affordable Care Act, shall only be accomplished after the
14initial report by the task force is issued.

15Section 4.  Federally facilitated exchange within the
16Commonwealth prior to the task force report.

17(a)  Interaction with Federal Government.--Nothing in this
18act may be construed to impede the Governor's Office, the
19Department of Public Welfare and the Insurance Department from
20communicating and interacting with the Federal Government with
21respect to the establishment of a federally facilitated exchange
22for this Commonwealth.

23(b)  Operation of specific functions.--Subject to the
24requirements of this act, the Department of Public Welfare and
25the Insurance Department may operate specific functions of a
26federally facilitated exchange consistent with this section to
27enable the continuation of traditional areas of State regulation
28and authority.

29(c)  Objectives.--State agency activities relating to any
30federally facilitated exchange for this Commonwealth shall be

1consistent with the following objectives:

2(1)  Promoting preservation of the private delivery of
3health coverage through commercial or nonprofit carriers and
4producers to the greatest degree possible under the
5Affordable Care Act and minimizing interference with the
6operation of these markets.

7(2)  Maximizing the funds spent on providing medical
8services while minimizing costs, including, but not limited
9to, administrative expenses.

10(3)  Promoting competition and consumer choice by
11advocating for the allowance of all health and dental plans
12that meet the minimum requirements necessary to be certified
13as qualified plans under the Affordable Care Act and to be
14offered in the exchange.

15(4)  Preserving to the greatest extent possible the
16State's insurance regulatory authority and the State's
17flexibility in determining Medicaid eligibility standards and
18program design and operation.

19(5)  Protecting the insurance requirements and directives
20established by the General Assembly that require insurance
21coverage for various illnesses, conditions, medical
22procedures, tests and treatments.

23(6)  Prohibiting the use of Federal or State funds for
24any procedures where State law forbids the use of those
25funds.

26Section 4.  Powers and duties of commissioner.

27(a)  Retention of authority.--In the event a federally
28facilitated exchange is established for the Commonwealth, the
29commissioner shall retain authority with respect to insurance
30products sold in this Commonwealth on the federally facilitated

1exchange to the maximum extent possible by law, including, but
2not limited to, producer and insurer licensing, form and rate
3approval, reinsurance and other risk-sharing mechanisms, network
4adequacy, compliance with insurance requirements, mandates or
5directives established by law or regulation, industry
6assessments, internal grievance standards, external review and
7unfair trade practices.

8(b)  Enrollment permitted.--The commissioner shall,
9consistent with the requirements of the Affordable Care Act,
10allow producers to enroll individuals, employers or employees in
11qualified health plans offered through a federally facilitated
12exchange in this Commonwealth, including enrollment using
13Internet websites.

14(c)  Regulations.--The commissioner may promulgate
15regulations as necessary to perform the duties specified in this
16section and to protect against adverse selection by creating
17equity between a federally facilitated exchange and the
18commercial or nonprofit health insurance market.

19(d)  Review.--The commissioner shall establish a policy and
20procedure to review the enrollment of all individuals who are
21deemed to qualify for the Children's Health Insurance Program
22under Title XXI of the Social Security Act (49 Stat. 620, 42
23U.S.C. § 301 et seq.).

24Section 5.  Powers and duties of secretary.

25(a)  General rule.--The secretary may establish eligibility
26standards, enrollment procedures and outreach mechanisms for
27persons who are enrolled through a federally facilitated
28exchange in this Commonwealth in the Medicaid program under
29Title XIX of the Social Security Act (49 Stat. 620, 42 U.S.C. §
30301 et seq.).

1(b)  Regulations.--The secretary may promulgate regulations
2as necessary to fulfill the purposes of this section.

3Section 6.  Health Insurance Exchange Task Force.

4(a)  Establishment.--The Health Insurance Exchange Task Force
5is established and shall consist of the following members:

6(1)  Four senators, two appointed by the President pro
7tempore of the Senate, in consultation with the Senate
8Majority Leader, and two senators appointed by the Senate
9Minority Leader.

10(2)  Four representatives, two representatives appointed
11by the Speaker of the House of Representatives, in
12consultation with the Majority Leader of the House of
13Representatives, and two representatives appointed by the
14Minority Leader of the House of Representatives.

15(3)  Two representatives from the business community in
16this Commonwealth appointed by the Governor.

17(4)  Two representatives from domestic insurance
18companies appointed by the Governor.

19(5)  One insurance producer appointed by the Governor.

20(6)  One medical provider appointed by the Governor.

21(7)  One person representing hospitals in this
22Commonwealth appointed by the Governor.

23(8)  One person representing consumers in this
24Commonwealth appointed by the Governor.

25(9)  The secretary, or a designee.

26(10) The commissioner, or a designee.

27(11) The Secretary of Health, or a designee.

28(b)  Study.--The task force shall conduct a study of whether
29to expand medical assistance coverage, including review of a
30regional exchange, as provided in the Affordable Care Act, or

1whether to explore a Pennsylvania health insurance exchange. The
2study shall: 

3(1)  Recommend whether the Commonwealth should proceed
4with Medicaid expansion, as proposed in the Affordable Care
5Act, including the following:

6(i) Review current Medicaid benefits offered in this
7Commonwealth in relation to those offered in other
8states.

9(ii) Review current costs and expenses incurred by
10the Commonwealth in addition to medical services.

11(iii) Review costs associated with health care costs
12incurred by the states to those who would be eligible for
13Medicaid if access were expanded.

14(iv)  Identify items that shall be eliminated from
15the annual appropriation due to expansion of Medicaid.

16(2)  Evaluate how a Pennsylvania health insurance
17exchange would benefit from the operation of a private
18marketplace for health insurance by allowing consumers to
19comparison shop for health insurance and by reducing the
20marketing cost for health insurance without the intervention
21of the Federal or State government.

22(3)  Explore options being considered by other states for
23developing and operating health insurance exchange
24alternatives, emphasizing free-market solutions to expand
25health insurance coverage.

26(4)  Evaluate whether an alternative Pennsylvania health
27insurance exchange should offer a full scope of services or
28whether a more limited scope of services is appropriate.

29(5)  Recommend whether the Commonwealth should proceed
30with the development of a Commonwealth-specific health

1insurance exchange if the related provisions in the
2Affordable Care Act are revised or repealed.

3(6)  Examine whether an exchange can be used to
4facilitate the sale of health insurance across state lines.

5(c)  Experts.--The task force shall have the authority to
6contract with experts and consultants as may be useful in
7conducting the study under subsection (b). The task force shall
8have the authority to request data and information, with no
9identifying information in order to protect patient privacy,
10from the Pennsylvania Health Care Cost Containment Council, the
11Department of Health, the Department of Public Welfare and the
12Insurance Department. Any requests by the task force shall take
13priority over any other report to be issued by the Pennsylvania
14Health Care Cost Containment Council.

15(d)  Costs of study.--The study under subsection (b) shall be
16paid for, to the extent possible, by a Federal grant awarded to
17the Commonwealth for planning and establishing insurance
18exchanges. The following shall apply:

19(1)  Information requested by the task force from the
20Pennsylvania Health Care Cost Containment Council shall be
21provided at no cost to the task force.

22(2)  Any request from the task force to the Pennsylvania
23Health Care Cost Containment Council shall be prioritized
24above any other report issued by Pennsylvania Health Care
25Cost Containment Council.

26(e)  Deadline.--An initial report shall be provided to the
27Governor, the Senate and the House of Representatives by
28December 1, 2013.

29Section 7.  Effective date.

30This act shall take effect immediately.