Medicaid Expansion

Gov. Tom Corbett and Gov.-elect Tom Wolf are doing a bit of interregnum sparring over how to add hundreds of thousands of low-income Pennsylvanians to the state's Medicaid rolls.

There's a simple question at the center of their disagreement: should the guy in charge push his policies, or defer to the new guy's preferences?

Wolf favors full Medicaid expansion, authorized by the federal health care overhaul and designed to open up federally-covered health care benefits to Pennsylvanians whose income is 138 percent of the federal poverty level.

90.5 WESA is exploring several of the key issues being debated as part of the 2014 Pennsylvania gubernatorial campaign.

Medicaid Expansion

Gov. Tom Corbett’s Healthy Pennsylvania substitute for the federal Medicaid expansion was officially accepted by the Department of Health and Human Services on August 28. The plan would use federal subsidies to offer private insurance plans to more than 600,000 low-income residents who qualify.

Democratic gubernatorial nominee Tom Wolf made a campaign trip to Pittsburgh Friday, and the topics of discussion were as diverse as the site of his stop.

Wolf toured the Bidwell Training Center in Manchester which offers students career-learning opportunities in fields ranging from chemical laboratory technician to the culinary arts, from horticultural to jazz.

Matt Rourke / The Associated Press

The federal government has approved Gov. Tom Corbett’s alternative to Medicaid expansion, the culmination of a roughly year-long negotiation to use federal money to subsidize private insurance plans for low-income Pennsylvanians.

Healthcare advocates, along with State Rep. Dan Frankel (D-Allegheny), unveiled an online ticker today, which tracks the amount of money they claim Pennsylvania is losing by rejecting Medicaid expansion.

As of today, the state has missed out on more than $640 million since the start of 2014, according to the ticker.

“It’s hard to turn your back against this when it addresses so many important issues facing the state at this time,” Frankel said.

Gov. Tom Corbett on Wednesday officially began seeking federal approval for his plan to bring billions of federal Medicaid expansion dollars to Pennsylvania to cover a half-million working poor residents through private health plans, although advocates for the poor and uninsured called it bureaucratic and punitive.

The Corbett administration has made its alternative proposal to the Affordable Care Act’s Medicaid expansion available to the public.

It’s one step closer to receiving federal review of a plan that would allow hundreds of thousands of people to enroll in private health insurance plans subsidized with federal funds.

About 400 nurses will descend on Market Square downtown Thursday afternoon to educate people about the Affordable Care Act - each with their own story.

Michelle Boyle, a nurse at Allegheny General, believes her mother-in-law would still be alive if the Affordable Care Act had been enacted sooner.

“My mother-in-law, she was 58, and she lost her job, she lost her health insurance, and a year later, she lost her life because she kept on being denied because she had pre-existing conditions,” Boyle said.

Sources within the Corbett administration say the governor will make an announcement about proposed changes to Medicaid Monday afternoon. It may take some time to answer questions about the fiscal prudence of the plan - and whether it can satisfy the federal government.

What's being proposed isn't an expansion, administration officials emphasize. They've hinted at a plan that would make reforms to Medicaid and use federal dollars to subsidize private health insurance for low-income Pennsylvanians.

A state Senate Republican is taking another shot at expanding the commonwealth’s Medicaid program.
    
Sen. Pat Vance of Cumberland County is returning to the issue after failing to get final approval during the twilight hours of the June budgeting frenzy.
    
The Corbett administration is still in negotiations with federal officials over a possible expansion, and Vance says she’s not sure anything has changed.

If there’s any expansion at all to move hundreds of thousands more Pennsylvanians onto the Medicaid rolls, it’ll have to be custom-made for the commonwealth.

Department of Public Welfare Secretary Bev Mackereth says her staff is looking at how other states have made the expansion a partly public-private partnership – sending people to buy health care insurance from the federally mandated exchange and using federal dollars to pay for it.

Other things, she says, require more negotiation.

Under the Affordable Care Act, each state’s governor must decide whether to expand Medicaid, with the federal government picking up the whole tab for the first three years and 90 percent thereafter.

The Pennsylvania Senate supported expansion in a vote Friday night, but there is a different attitude in the House.

Steve Miskin, spokesman for the House Republican Caucus, said the House has not and will not consider expanding Medicaid as it exists now.   

A vote is looming in a state Senate committee on legislation to potentially expand Medicaid eligibility to hundreds of thousands of Pennsylvanians under the 2010 federal health care law.

“I cannot say enough about the importance for those individuals who don’t have health insurance, who are working every day, about a half a million people in Pennsylvania, how significant it could be for their lives, and for all of us,” said Sen. Vincent Hughes (D-PA-7.)

The Consumer Health Coalition (CHC) has taken its fight to the Capitol to show lawmakers what is “on the line” if they choose not to expand Pennsylvania’s Medicaid.

CHC Director of Advocacy and Consumer Engagement Reverend Sally Jo Snyder said expansion is a life or death decision.

Flickr

When the Supreme Court's ruled in favor of the Affordable Care Act (ACA) last year, they gave states the option to opt out of the law's Medicaid expansion. This left the decision of whether or not to participate in the hands of our governors and state lawmakers.

If adopted in Pennsylvania, the Medicaid expansion would cover people earning up to 138 percent of the federal poverty level, about $15,400 for a single person and $31,800 for a family of four. And the federal government  would pay 100 percent of the cost of the expansion for the first three years, with the federal share dropping to 90 percent by 2021 and remaining 90 percent thereafter.

Governor Corbett has said he does not want to adopt the expansion because it would "add to a budget burden that's unsustainable. "

Law professor and political analyst Joe Sabino Mistick and Pittsburgh Post-Gazette columnist Tony Norman discuss presumptive mayor elect Bill Peduto and his plans for Pittsburgh. Also, with summer recess coming up, it's crunch time for the state legislature. What's the outlook on medicaid expansion?

State Senate Democrats are trying to compel the state to participate in a Medicaid expansion by using what's called a discharge resolution.

Senate staffers on both sides of the aisle are at a loss to remember the last time this kind of maneuver was successful. It doesn't preclude the majority party from sidestepping a vote on the measure in question.

But that's not stopping Sen. Vincent Hughes.

Legislative leaders on both sides of the aisle in the state Senate are noting the time is fast approaching to make a final decision about a potential expansion of Medicaid.

For months, the Corbett administration has insisted that the door is not closed to such a move.

Senate Republican Majority Leader Dominic Pileggi - not exactly a public cheerleader for the move - said last week the governor needs to decide soon whether he'll allow hundreds of thousands more Pennsylvanians to enroll in the program.

A new study finds expanding Medicaid eligibility in Pennsylvania would yield billions of dollars in federal funding and result in hundreds of millions of dollars in additional state tax revenue over the next eight years.

The Independent Fiscal Office report says the expansion would mean big cost-savings for the commonwealth — due largely to the number of people whose medical coverage would be picked up by the feds.

But baked into the study are several assumptions necessary for completing a fiscal analysis, said IFO director Matthew Knittel.

The head of the state Department of Public Welfare is sounding an optimistic note about a possible Medicaid expansion in Pennsylvania.

Acting DPW secretary Bev Mackereth said she’s following up with federal officials about the topic of adding hundreds of thousands of Pennsylvanians to the government-run health insurance program.

She said federal officials have been forthcoming with information to the best of their ability.

Gov. Tom Corbett met with U.S. Department of Health and Human Services Secretary Kathleen Sebelius on Tuesday night to discuss, among other things, potential Medicaid expansion in the state. 

Expanding Medicaid, the federal-state medical assistance program, would cover thousands more people in Pennsylvania. Part of the Affordable Care Act, governors have the option to decide if they will expand coverage in their states.

Corbett has said he won't because he doesn't think the state can sustain the costs of the program over time. 

All eyes will be on the governor in the days following his April 2 tete-a-tete with U.S. Health and Human Services Secretary Kathleen Sebelius.

Ever since Gov. Corbett said he would go straight to the source to answer some of his remaining questions about a Medicaid expansion, the pressure mounting over the issue has subsided.

Even state Senate Democrats, the Legislature’s loudest champions of expanding Medicaid, are easing off their criticism of the governor’s reluctance to add hundreds of thousands of Pennsylvanians to the government-run health insurance program.

Labor and healthcare advocacy groups are using this April Fool's Day to make a point: that Gov. Tom Corbett's decision to forego a federally funded expansion of Medicaid in Pennsylvania is, well, foolish.

Members of three groups — Working America, the Pennsylvania Health Access Network and the Consumer Health Coalition — plan to deliver 9,000 petitions to Corbett's office urging the administration to lower eligibility requirements for the federal program.

As state lawmakers wrap up three weeks of budget hearings in Harrisburg, the issue of a possible Medicaid expansion has come up framed as a matter of dollars and cents. But the possible political ramifications also loom over the issue.

Democrats have been hammering the governor on the issue of a Medicaid expansion. They support it and, in recent weeks, it looks like Corbett could be swayed. He is expected to meet with federal authorities to go over what an expansion could mean for Pennsylvania.

Ben Ostrowsky / Flickr

As more Republican governor's adopt the Medicaid Expansion, Governor Corbett is under more pressure to adopt the program. We'll discuss the impact of the Medicaid Expansion program on Pennsylvania women and low-income families with Judy Waxman, Vice President for Health Policy and Reproductive Rights for the National Women's Law Center.

Talks on a possible Medicaid expansion on Pennsylvania appear to depend on a meeting that is not yet on the governor’s schedule.  In the meantime, state lawmakers are bickering over dueling cost estimates and whether to trust a federal funding formula for Medicaid expansion.

Governor Tom Corbett said one of the reasons he is choosing to not expand Medicaid “at this time” is because he’s unsure about relying on the federal government to foot the bill, now and in the future.