PRINTER'S NO. 1874
No. 1595 Session of 1989
INTRODUCED BY DORR, MAIALE, D. W. SNYDER, MORRIS, TRELLO,
McVERRY, SCHULER, FLEAGLE, ROBINSON, SEMMEL, MRKONIC, NAHILL,
WILSON, HALUSKA, BURD, DISTLER, BELFANTI, JACKSON, TELEK,
SAURMAN, BARLEY, GEIST, JOHNSON, HOWLETT, LANGTRY, NOYE,
ALLEN, FOX, E. Z. TAYLOR, HAGARTY, BUNT, LASHINGER, RITTER
AND TIGUE, MAY 31, 1989
REFERRED TO COMMITTEE ON INSURANCE, MAY 31, 1989
AN ACT
1 Providing for health insurance demonstration projects.
2 The General Assembly of the Commonwealth of Pennsylvania
3 hereby enacts as follows:
4 Section 1. Short title.
5 This act shall be known and may be cited as the Health
6 Insurance Demonstration Act.
7 Section 2. Declaration of policy.
8 The General Assembly finds and declares as follows:
9 (1) There are an estimated one million Pennsylvanians
10 without health insurance coverage.
11 (2) Many individuals and employers are unable to
12 purchase health insurance because of the high cost of health
13 insurance premiums.
14 (3) Uninsured individuals may postpone necessary health
15 care which may lead to more serious illness.
1 Section 3. Definitions.
2 The following words and phrases when used in this act shall
3 have the meanings given to them in this section unless the
4 context clearly indicates otherwise:
5 "Medically indigent." The status of persons who have no
6 public or private health insurance benefits and whose annual
7 income or the income of the primary wage earner in the household
8 is less than 150% of the Federal poverty level for a family of
9 four as published by the United States Department of Health and
10 Human Services.
11 Section 4. Demonstration requirements.
12 (a) Regional programs.--The Insurance Commissioner, in
13 consultation with the Secretary of Health and the Secretary of
14 Public Welfare, shall develop four health insurance proposals
15 for different geographic regions in this Commonwealth to provide
16 experience and to demonstrate the capacity of programs chosen to
17 provide access to necessary health care for medically indigent
18 persons. There shall be a demonstration project to test each of
19 the following health insurance benefits and delivery mechanisms:
20 (1) Coverage for primary health care and preventive
21 services.
22 (2) Coverage for inpatient health care services.
23 (3) A managed health care program.
24 (4) A medical assistance buy-in.
25 (b) Limitation.--For the purpose of the demonstration
26 projects, State-mandated benefits shall not apply.
27 Section 5. Contracts for demonstration projects.
28 (a) Power of Insurance Department.--The Insurance Department
29 shall contract with qualified vendors to insure and administer
30 demonstration projects.
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1 (b) Public bidding.--The contracts shall be awarded after a
2 public bidding process, except for the Medical Assistance buy-in
3 project, which shall be administered by the Department of Public
4 Welfare.
5 (c) Cost containment required.--All contractors shall be
6 required to demonstrate health care cost containment strategies.
7 Section 6. Evaluation.
8 (a) Evaluation period.--The Insurance Department, in
9 cooperation with the Department of Health, shall conduct an
10 evaluation within 18 months of the effective date of this act.
11 (b) Contents.--The evaluation shall include the following:
12 (1) A description of the uninsured population in the
13 geographic region served by each demonstration project before
14 health insurance was offered and 12 months following the
15 provision of health insurance by the contract vendor to
16 identify any change in the number of uninsured persons and
17 any shift from health insurance programs to the demonstration
18 projects.
19 (2) The cost per beneficiary of providing health care
20 insurance coverage in each demonstration area by the contract
21 vendor and the average cost of a health insurance policy in
22 the same geographic area provided by the other insurers with
23 similar benefit packages.
24 (3) The health status of the beneficiaries as described
25 by the beneficiaries at the time of enrollment and 12 months
26 following enrollment.
27 (4) Changes, if any, in the utilization patterns of
28 health care by enrollees in the demonstration projects.
29 (5) Changes, if any, in the amount of charity care, as
30 defined by the Health Care Cost Containment Council, provided
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1 by hospitals in the geographic areas served by demonstration
2 projects.
3 Section 7. Appropriation.
4 The sum of $4,000,000, or as much thereof as may be
5 necessary, is hereby appropriated to the Insurance Department to
6 carry out the provisions of this act relating to subsidies to
7 providers of health care insurance for low-income beneficiaries.
8 Section 8. Sunset.
9 This act shall expire December 31, 1992, unless reestablished
10 prior to that date in accordance with the act of December 22,
11 1981 (P.L.508, No.142), known as the Sunset Act.
12 Section 9. Effective date.
13 This act shall take effect July 1, 1989.
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