Growing up I remember watching the game show "Let's Make a Deal," the centerpiece of which was forcing contestants to select an unknown prize: to essentially gamble on making the right choice.
Would it be what's behind curtain No. 1 or door No. 2, the new car or the live llama?
For the last two years, we've been asked to play a version of "Let's Make a Deal" with the U.S. Department of Health and Human Services on the issue of whether Pennsylvania would build a state health insurance exchange or opt to have the federal government operate an exchange for us.
The federal Patient Protection and Affordable Care Act provided that all states must have a health insurance exchange operational by Oct. 1, 2013, in order for consumers to purchase insurance by 2014.
Building an insurance exchange is not like helping my 7-year-old son with a Lego project. The ACA requires the creation of a new way of purchasing health insurance, using technologies and distribution systems that don't exist in most states and that would cost millions of taxpayer dollars to build.
It must be done in a cost-effective and sustainable manner that allows Pennsylvania flexibility in managing the operations for our insurance marketplace.
During the past two years the Pennsylvania Insurance Department has been trying to understand the implications of building such an exchange.
We've held discussions with interested parties, performed studies and secured vendors and funding to assist with and prepare for the establishment of a state-based exchange, with the assumption that it might be the best option.
All options were considered.
Four months ago, after repeated requests for more information, we recorded our primary outstanding questions for HHS.
Fewer than five days before the deadline for states to declare their intentions regarding exchanges, HHS issued a general letter with some answers and guidance.
There was not enough information, however, and it was given too late to be useful.
States are being asked to make uninformed choices - do you want to go with what's behind curtain No. 1 or opt for what's in box No 2? Health insurance is not a game for the millions of Pennsylvanians who depend on it.
Gov. Tom Corbett wasn't ready to gamble on the unknowns associated with a state exchange when it involves the health care of Pennsylvanians and millions of taxpayer dollars. It is for these reasons that Pennsylvania has elected not to create a state-based exchange and instead opt for more certainty in having a federally-facilitated exchange to operate in the state.
We understand the frustration of Pennsylvanians wanting to understand what will be happening with their health insurance.
We share that frustration. We are committed to working through all the uncertainty and getting consumers what they need to make informed decisions.
By law, the decision to establish a state-based exchange can be re-evaluated each year. But, consumers, employers, medical providers and health insurers need to understand now what will happen in 2014. Without timely and comprehensive guidance from HHS, this is the only reasonable decision.
We will work with the federal government to determine how consumers may compare health plans and what plans may be sold on the exchange. We will work on what the plans should cover for individuals and small businesses.
Improving access and affordability of health insurance remains a priority for the Corbett administration, but we're going to do so in a deliberate and considered manner. This issue is far too important to treat like a game show.
Please stay tuned and visit our website - www.insurance.pa.gov - for more details.
Michael Consedine is the state insurance commissioner.