[{"_1":2,"_112":-5,"_113":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6297113,"mediaKeyId","2511254-fcdbf541e2d37041a2cb67c8d6522813","parentId",2511254,"title","Penny: end of enhanced federal premium tax credits could push hundreds of thousands from coverage; state affordability option proposed","audioSeconds",150,"startMs",2198000,"endMs",2348000,"viewUrl","/Search/View?dp=1&key=2511254-fcdbf541e2d37041a2cb67c8d6522813&start=2198&end=2348","thumbnailUrl","https://assets.pipeline.soar.com/2511254-fcdbf541e2d37041a2cb67c8d6522813/thumbnail_2198000.jpg","articleUrl","/articles/6297113/Pennsylvania/Penny-end-of-enhanced-federal-premium-tax-credits-could-push-hundreds-of-thousands-from-coverage-state-affordability-option-proposed","mediaUrl","https://secure.pipeline.soar.com/6297113-b6261ee1ecea7f875cfa1346e8c0b283/orig.mp4?Expires=1770497854&Signature=A60knFCIQz7BFGnBIMSrSwO3sAEPLFNz3dJda88dmQHKWCYjflBGwziO6lGMEUKM~9w4taZLUYsHGPmIA804uyQeCnkusB-D3qRxCN1Aua6cY2ovt78oB5VcSKxoNBWuRkYjsa3rkHQWkbh2MTw8u-YUnW0sLm~SrD9Nj8Y74pwVzUohMw1ILS49z7ndV1k5UscYF7siW1exkCVQVNxQe~cRzLOlk5HoFIoq765cLcx15mgeDePT6sl-73rsZbJH4BY52NDYuHx6VsqvDE4amG9uqzet7Pbd44Eo9tYLSVPosLSOmY4nU60NZWCApNkLY~8Wx43n3hxlzzlik8ocpA__&Key-Pair-Id=KUT5TJCACFTXG","author","Pennsylvania House of Representatives","date","2025-02-28T17:46:38Z","article","Devon Trolli, executive director of Penny (Pennsylvania's health insurance marketplace), told a legislative budget hearing that the federal enhanced premium tax credits under the American Rescue Plan and later legislation spurred a nearly 50% jump in Marketplace enrollment and helped Penny reach record coverage levels — roughly a half‑million Pennsylvanians.

Trolli warned lawmakers that the enhanced credits are scheduled to expire under current federal law at the end of the year, and that failure by Congress to extend them could have large effects. \"If those [enhanced tax credits] were to go away ... Penny enrollees would be looking at an 82% premium increase,\" Trolli said, adding that in many rural areas premiums could double. He estimated that about 435,000 of Penny's enrollees would be affected and said the program could see around 150,000 people drop coverage if the credits lapse.

Lawmakers discussed state options to shore up affordability. Director Trolli and other department witnesses described a proposed State Affordability Program that, in the department's outline, would target households with incomes between about $22,000 and $45,000 annually. Under the structure discussed by staff, a relatively modest premium subsidy (the department used an example of $20 per month) could allow enrollees to \"buy up\" to richer plans, reducing out‑of‑pocket exposure and delivering multiple times the premium cost in reduced cost‑sharing.

\"We have a lot of people who are just barely or not affording coverage,\" Trolli said. The department cited survey results showing roughly 80% of uninsured respondents reported cost as the primary barrier to coverage and that about 60% of current enrollees consider their coverage barely affordable.

The department said it would automatically apply state affordability benefits at open enrollment for qualifying Penny enrollees and encouraged lawmakers to fund the program. The hearing included requests from legislators for contingency planning materials the administration said it would supply.","mediaType","Video","parentTitle","Appropriations Committee -- March 5, 2025","oneSentenceSummary","Devon Trolli, executive director of Penny, told lawmakers that if Congress does not extend enhanced federal premium tax credits beyond 2025, Pennsylvanians on the exchange could face average premium increases of 82% and as many as about 150,000 people could drop coverage.","taxTitle","Appropriations, House of Representatives, Legislative, Pennsylvania","taxId",29233,"location","Pennsylvania","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6297118,"Department: independent external reviews overturned just over half of denials; market conduct team to probe trends",205,1441000,1646000,"/Search/View?dp=1&key=2511254-fcdbf541e2d37041a2cb67c8d6522813&start=1441&end=1646","https://assets.pipeline.soar.com/2511254-fcdbf541e2d37041a2cb67c8d6522813/thumbnail_1441000.jpg","/articles/6297118/Pennsylvania/Department-independent-external-reviews-overturned-just-over-half-of-denials-market-conduct-team-to-probe-trends","https://secure.pipeline.soar.com/6297118-0045c448ba2a41c863401bc990c59c37/orig.mp4?Expires=1770497854&Signature=JOlO8hM~SDxPHioG517aaNaAygzfr178UaNuzLy4mdT2J8dUoSVk5xqqFCjo-9aPJg-C7ssEAT2-jVSerrVIc58SLGbFMf1M4Ypkqx1UJJQ7XTP9MLhVM2Hd9HA9yrWUdVmGsC9fJ5XNsLcFJ7-wgfX-UIpvnAw99gmq0MhFqwCWEXCMa5wPxYw0ydnG8b3S6qNYKjkNfkMfZsMQsCLH50CDeDFHfJFHPRzMCGtJNmeLXH7hUu4u0whzkBHHA55fuzw~5kHTY874ECNDIA6hoVGcTh-GAN7DpzmQNOcvDFAAaXh3LPhXDQfb6OQtGXntneJV2~JCUS~q4B5pDa4eRA__&Key-Pair-Id=KUT5TJCACFTXG","The Pennsylvania Insurance Department reported that, in the first year after shifting external review oversight to the state, independent review organizations overturned just over half of adverse insurer decisions that reached external review. Commissioner Humphreys told legislators the department's data shows a 50.6% overturn rate for cases sent to independent review.

Representative Frio described cases where families and children were denied coverage for treatments later found to be medically necessary, including an anecdote about a 5‑year‑old with a life‑threatening condition whose coverage was initially denied and later overturned on appeal. \"He's denied. How is that morally right?\" Frio asked during the hearing, stressing the human stakes behind the statistics.

Humphreys said the department's market conduct unit will use the earlier reporting to drill down into company practices. \"If we see a pattern or practice where a company continues to deny something that they should otherwise cover, that can subject them to restitution, fines, penalties,\" she said, identifying market conduct investigations and remediation as follow‑up work.

The department explained that external review generally comes after two levels of internal insurer review and that the independent review stage is designed to give an unbiased assessment of medical necessity and policy coverage. Humphreys said concern is not only that denials are overturned when appealed, but that many policyholders never pursue appeal rights and therefore never get the reversal their cases might merit.

The market conduct team — which the commissioner indicated would pursue examinations and potential enforcement — includes staff members specifically assigned to systematically review overturn trends, prior authorization practices, and whether insurers are meeting policy terms approved by the department.","At a budget hearing, the Pennsylvania Insurance Department told lawmakers that independent external reviews overturned 50.6% of appealed adverse coverage decisions in the program's first year, prompting market conduct reviews and the possibility of restitution or penalties for insurers that show patterns of inappropriate denials.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6297123,"Insurance department seeks increased budget, adds staff to enforce Act 77 on PBMs",76,866000,942000,"/Search/View?dp=1&key=2511254-fcdbf541e2d37041a2cb67c8d6522813&start=866&end=942","https://assets.pipeline.soar.com/2511254-fcdbf541e2d37041a2cb67c8d6522813/thumbnail_866000.jpg","/articles/6297123/Pennsylvania/Insurance-department-seeks-increased-budget-adds-staff-to-enforce-Act-77-on-PBMs","https://secure.pipeline.soar.com/6297123-94637a279f2fda182dc0302f1dcaed05/orig.mp4?Expires=1770497854&Signature=aEl4RT6gsLemP97Up-oopKqGxfpi2GObDdxqTJLeqSk~JQuSWraXrFRmkR40F5t1Yua2xMgEYxJz8p3mJX558NgT~c61qFWKfJrholkpmnhPI~dnavuVZq6GAmA2HD8r22pslLUk1LtpSP0vuU6tS9LjnRQZ4Se2DXIPPwpKvprEwa0quE1bwYch2hoN16JwXpVVGd-wWgMENCGB9L3jt9MnazJVsqb1IAe~4mZrgKNR2jau0ocpeFfBXg2Ze50K36mFNk5ohFxySAuzRJ~Z22zNYH59oZq2N18pV5JvaV9dNh8qNCWXzypPwrcLWHA1RFVMHFAAcqDwovIZyVLEqQ__&Key-Pair-Id=KUT5TJCACFTXG","The Pennsylvania Insurance Department outlined its 2025 budget request during a legislative budget hearing and said it seeks roughly $43 million — a $3.9 million increase — while the state health insurance exchange, Penny, asked for about $52 million, an $11.4 million increase. Commissioner Humphreys and staff told lawmakers most of the funds for both entities come from fees and other non‑general‑fund sources.

Lawmakers pressed the department about provisions added to the budget to support enforcement of Act 77, the 2024 law that expanded state oversight of pharmacy benefit managers. Representative Mullins asked specifically how new staff would be used; Commissioner Humphreys said the hires would be spread across consumer complaints, rate and product review, and legal appeals, including positions to adjudicate appeals involving specialty drugs.

\"A few positions will be dedicated to their rate review and product review side,\" Humphreys said, adding the department expects an increase in appeals from pharmacies and insurers and wants to adjudicate them \"as quickly as possible.\" The department said the proposed additions tied to Act 77 total eight staff in the Insurance Regulation and Oversight Fund line and would be paid from fee revenue rather than the general fund.

Lawmakers who represent rural and smaller community pharmacies emphasized local impact, telling the department that many independent pharmacies serve as front‑line health providers in their districts. The department repeated that the new staff would work on both intake of pharmacy complaints and on the legal side to speed adjudication.

Department staff at the table for the hearing included Chief of Staff Jody France and Budget Director Anu Upadi, who the commissioner identified when sworn testimony began.

Looking ahead, the department said it will use the new positions both for complaint intake and for adjudicatory work on disputes that arise under Act 77. No formal vote or appropriation was decided at the hearing; lawmakers asked the department for follow‑up budget detail.

Less urgent details: the department reiterated its long‑standing policy that most operating dollars come from assessments and fees, not direct general‑fund appropriations.","At a legislative budget hearing, the Pennsylvania Insurance Department said its 2025 budget request would increase operating appropriations and include staff additions to implement and enforce Act 77 governing pharmacy benefit managers (PBMs). Department leaders said most funds come from fees, not the general fund.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6297108,"Insurance oversight fund returns vary by snapshot; department cites timing, reconciliation rules",233,1156000,1389000,"/Search/View?dp=1&key=2511254-fcdbf541e2d37041a2cb67c8d6522813&start=1156&end=1389","https://assets.pipeline.soar.com/2511254-fcdbf541e2d37041a2cb67c8d6522813/thumbnail_1156000.jpg","/articles/6297108/Pennsylvania/Insurance-oversight-fund-returns-vary-by-snapshot-department-cites-timing-reconciliation-rules","https://secure.pipeline.soar.com/6297108-62a6ae06929d3cb278f79cb01d58dd67/orig.mp4?Expires=1770497854&Signature=a6Yphx5wzpCdfZIc1HSFI9o0S2EYEAoiYy0wklMFxkd~zUUmLW~EbGz73dGQ0lY0YbUrdzkvTaZb5~9hvamDXvb2Wxx70hkqRF8UoNVHINP-Etls5cy5fdYDDk~GQ10l5neIQpE8kd95JQE4tuNRzuL-7Ra4kCix1s6Eh5fUw1TFTU7jvAfXC05RUTsv9efm2hMeXqdjgDlggxpUKD7Mh0IMjKQa~aUyFydMRo10atXQu7YLHyw56lF5LBNHa0H1pW5kuQjemB5LhA5ocRLfcs~oZHYkCFdUm15L3g2Y4X7DWpqCk7R981WXs~o~cDbaA0to366S24QZ5q9PlwqIAA__&Key-Pair-Id=KUT5TJCACFTXG","During the hearing, Representatives Brown and Marcel asked why the amounts listed as returns from the Insurance Regulation and Oversight Fund (IROF) to the general fund differed across published budget documents. The department responded that the discrepancy is largely a timing issue: revenue flows are concentrated in a few months and different reports capture different snapshots.

Representative Brown observed a decline in the projected return to the general fund and asked whether the amount being returned would eventually disappear. Commissioner Humphreys and department budget staff said they do not expect the giveback to disappear and noted March–April are the department's heaviest revenue months because many fees and renewals occur then. The department cited prior examples where year‑of snapshots underprojected final givebacks because later invoices and receipts raised the total returned amount.

The department explained statutory constraints that affect how much the agency keeps. Staff described a 50/50 split on some receipts and an Act 46 (2013) requirement that the Insurance Department can retain only what it spent for the prior year's appropriated budget; excess cash is reconciled and returned to the general fund.

Budget Director Anu Upadi said the two documents cited by lawmakers were taken at different snapshots in time and that a more current snapshot would likely show a higher giveback because the department's largest revenue months were ahead. Lawmakers requested the department provide updated IROF balance detail, total receipts, and total disbursements for committee review.","Lawmakers questioned why projections for returns from the Insurance Regulation and Oversight Fund (IROF) to the general fund have dropped in some projections. The department said differences reflect timing and reconciliation rules under state law and that monthly fee receipts are concentrated in February–April.","actionData","errors"]

Article not found

Penny: end of enhanced federal premium tax credits could push hundreds of thousands from coverage; state affordability option proposed

Department: independent external reviews overturned just over half of denials; market conduct team to probe trends

Insurance department seeks increased budget, adds staff to enforce Act 77 on PBMs

Insurance oversight fund returns vary by snapshot; department cites timing, reconciliation rules