The PPACA encourages but does not require either action. Both decisions will have a large impact on what Pennsylvania's health care system looks like in coming years.
Many Congressional Republicans, including U.S. Sen. Pat Toomey and U.S. Rep. Joe Pitts, have signed a letter to the National Governors Association asking governors to oppose the PPACA by standing against any creation of state-based insurance exchanges.
On Tuesday, Kathleen Sibelius, secretary of health and human services, also sent governors a letter asking them to move forward with implementing the act. She also announced four regional implementation forums "to address challenges, answer questions, and talk about how we will continue moving forward."
Continuing the letter parade Tuesday, the Republican Governors Public Policy Committee sent President Barack Obama a letter containing 30 questions it deemed "critical" related to health insurance exchanges and Medicaid.
"My administration will do all we can to ensure the negative impact of this law affects the lives of Pennsylvanians as little as possible," Gov. Tom Corbett said in a news release immediately after the U.S. Supreme Court's June 28 decision. His statement did not include specifics on either the exchange or Medicaid questions.
The press office of the Pennsylvania Insurance Department said there were no updates since its statement June 29. At that point, it reported that research indicated a state-based exchange would be a better option than the default federal one, but that it had not been created and the governor had instructed that proceedings continue so it remained an option.
Carey Miller, director of communications for the state Department of Public Welfare, said no decisions had been made about expanding Medicaid in Pennsylvania.
"We're still reviewing the decision," she said.
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