Affordable Care Act, Health Disparities, Health Equity, Health Justice, Health Policy, Health Reform, Inequality, Medicaid, Pennsylvania

PA HB 2138 Heads to the Senate

Pennsylvania House Bill 2138 which would allow for work requirements in Medicaid has successfully been voted out of the Health Committee and will come to a full vote by the Senate. It is critical that PA residents contact their state senator now to urge him or her to vote NO on HB 2138.

This bill will unnecessarily punish families and children living in poverty at the administrative expense of taxpayers. Check out our past blog to remind yourself of how the law would work.

The Urban Institute did a comprehensive review of the literature on work requirements in public assistance programs and found that the evidence shows these programs fail to meet their stated goals at the detriment of individuals losing life-saving benefits.

Summary of Work Requirements in TANF, SNAP, and Housing Assistance Programs as of December 2017

This article was cross-posted at http://www.helpmlp.org

Affordable Care Act, Health Equity, Health Reform, Medicaid, Pennsylvania

Healthy Pennsylvania? Not exactly.

Tuesday afternoon the nation stood by waiting for Pennsylvania Governor, Tom Corbett, to announce that Pennsylvania would opt in to the Medicaid expansion provision of the Affordable Care Act.  The news viewers received instead was something very different.  Corbett made it clear that he was not “expanding Medicaid”, but providing a “common sense” plan to reform the state’s Medicaid program. The plan’s title, Healthy Pennsylvania, is quite the misnomer when one looks at the details.

The Healthy Pennsylvania objectives are threefold: reform Medicaid, increase access, and stabilize financing.  Reforming Medicaid is at the heart of the plan and includes many controversial proposals such as condensing the 14 existing Medicaid benefit plans into two alternative benefit packages; applying a $10 co-payment for “inappropriate” emergency room use; requiring applicants and beneficiaries to comply with work search requirements; and attaching a monthly premium for individuals who have incomes as little as 50% of the federal poverty level.

For the reasons below and others, I do not support Governor Corbett’s Healthy Pennsylvania plan.  It is unlikely that the federal government will approve it as well due to the many provisions presented in the plan that are contrary to the laws and regulations governing the Medicaid program. Instead of taking meaningful action to help improve access to care and health of Pennsylvanians, this proposal will act as a needless delay prohibiting hundreds of thousands of Pennsylvanians from getting comprehensive, affordable health coverage as set forth by the Affordable Care Act.

Consolidation

While it is true that the Medicaid program in Pennsylvania is complex, it serves a variety of different populations. For example, there is a plan for women who make slightly higher incomes to receive coverage for certain OBGYN services known as the Women’s Select Plan.  Another existing benefit in Pennsylvania is the Medical Assistance for Workers with Disabilities (MAWD).  This plan provides health coverage for workers with disabilities whose income would otherwise make them ineligible for the traditional Medicaid program in Pennsylvania.  The Governor’s proposal to consolidate the existing Medicaid programs leaves advocates questioning the fate of programs like these that serve specific groups.  Even more troubling is  that in addition to consolidation, the Governor would like the services covered by the plans to reflect that of employer-sponsored coverage.  The traditional Medicaid plan in Pennsylvania offers  coverage for a wide-range of coverage including comprehensive services for mental health and substance use challenges.  If this proposal were implemented it would significantly reduce the scope of services individuals would receive to keep them well.

Expansion

Within the Healthy Pennsylvania plan the Governor does agree to expand Medicaid eligibility for individuals up to 133% of the federal poverty level. He proposes to do this by enrolling those individuals into private health insurance plans on the Marketplace.  While this expansion of eligibility would increase access to some type of health coverage for individuals, it would do so in a way that is more costly and less efficient than enrolling individuals into traditional Medicaid.  The fact is that it is less costly to insure individuals through Medicaid than it does through the private health insurance market.

Cost Containment

In an effort, under the guise of cost savings and promoting personal responsibility, Corbett proposes to mandate several requirements under the Healthy Pennsylvania plan. Among the most controversial is the work search requirement. While the Governor stated that this requirement would only apply to “able bodied” individuals capable of working, his plan does not clearly define how this requirement would be applied and enforced.  Currently, no other states in the nation apply a work requirement to its Medicaid benefit.

Another controversial provision is the premium that individuals will need to pay for coverage. Individuals with incomes as low as 50% of the federal poverty level ($5,745/year) will be asked to pay a premium. The maximum premium an individual will pay will be $25 per month.  While $25 per month does not seem like much money to individuals who have steady incomes, for low-income individuals, it will act as a significant barrier to coverage and care.

One of the more alarming provisions set forth in the plan without any clarification or description is a $10 co-payment for “inappropriate” emergency room usage.  The plan fails to define or describe situations when using the emergency room would be inappropriate as opposed to appropriate.  The plan also fails to explain how this co-payment would be collected or who would be responsible for determining when the co-payment should be imposed on an individual.  Individuals and families who might be experiencing serious medical conditions could delay seeking emergency treatment due to this co-payment.  The Emergency Medical Treatment and Labor Act (EMTALA) was enacted to ensure all individuals had access to necessary health services in times of crises regardless of ability to pay.  Enacting a policy such as this can confuse individuals about their right to receive care in these settings.  If implemented this provision will unjustifiably penalize the poor.

The Governor’s plan can be accessed here: http://www.dpw.state.pa.us/healthypa/index.htm.

Comments on the plan can be submitted via email to: RA-PWHealthyPA@pa.gov or by mail to:

Department of Public Welfare,
Office of the Secretary,
Health & Welfare Building,
625 Forster Street,
Harrisburg, PA 17120

Education, Health Disparities, Health Equity, Inequality, Medication, Social Determinants of Health

Using Medication to Treat Social Ills

The critical need for a social determinants approach to health care is illustrated in an article in today’s NY Times.  In “Attention Disorder or Not, Pills to Help in School” Atlanta doctor, Michael Anderson, explains that he prescribes Adderall to help even the educational “playing field” for low-income students.  Prescribing Attention Deficit Hyperactivity Disorder (ADHD) medication helps provide an edge to low-income students who are often struggling in schools that are under-resourced, yet are competing with students from higher-income families and schools for college admissions.  Dr. Anderson sees himself as employing his form of “social justice” noting, “I don’t have a whole lot of choice. We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

The possible short and long-term effects of prescribing stimulant ADHD medication to adolescents are discussed within the article, and some may find it shocking that parents and physicians would choose to prescribe medications in light of these risks.  However, a quick look at national disparities data shows that obtaining higher education is a matter of life or death.  According to the Robert Wood Johnson Foundation, college graduates are expected to live at least five years longer than those who do not graduate from college.  A mother’s education is also correlated with infant mortality; the lower her educational attainment the higher the risk for infant mortality.  Additionally, the higher one’s education the less likely they are to develop chronic diseases such as diabetes, heart disease, and obesity.  While Dr. Anderson’s clinical practices are certainly controversial and guaranteed to invite criticism, I applaud him for exposing such an important issue and calling for policies that address the true causes of health and social inequities.