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Thoughts on Governor Corbett’s coming announcement re: Medicaid expansion in Pennsylvania

Public health advocates in Pennsylvania have been working tirelessly to influence Governor Corbett to “opt in” to Medicaid expansion since the U.S. Supreme Court made its surprising decision on June 28, 2012 regarding the Affordable Care Act (ACA).  The Governor’s office has leaked to the press that tomorrow we will get the news we have been waiting for during a big announcement the Governor is set to deliver.  One would think that advocates should welcome this news; however instead of celebrating, many of us are gearing up for our next challenge: explaining to the public and the legislature why we will not support Governor Corbett’s Medicaid expansion proposal.

For months Governor Corbett adamantly opposed expanding Medicaid eligibility citing misleading financial analyses, over reliance on the Medicaid program, and unsubstantiated fears that the federal government will “break its promise” regarding the 100% federal matching rate for the program for years 2014, 2015, and 2016.  More recently, as the Governor’s political popularity continues to dwindle, he has moved from adamantly opposing expansion to considering options within expansion.  Based on recent statements by the Governor, the Pennsylvania Department of Welfare Secretary, Beverly Mackereth, and the Insurance Commissioner, Michael Consedine, it is very likely that the Governor’s proposal will be similar to those of Arkansas and Iowa.  Governor Corbett favors privatization and it is likely he will propose expanding Medicaid eligibility for individuals, but instead of enrolling them into the traditional Medicaid program, the newly eligible individuals will be enrolled into the private health insurance plans on the Marketplace. In addition to this, the Governor will likely request a waiver from moving children in households with incomes up to 138% of the federal poverty level from CHIP into the Medicaid program; a provision of the ACA to which the Governor has expressed great opposition.  Other items the Governor might propose as part of the Medicaid expansion in Pennsylvania could include work requirements and increased co-payments for services. With the maintenance of effort requirement of the ACA expiring at the end of the year, advocates also fear Governor Corbett’s expansion plan will unfortunately come with a reduction in the current Medicaid benefit, negatively impacting our most vulnerable residents.

Governor Corbett is making the issue of Medicaid expansion in Pennsylvania needlessly complex in order to satisfy both a Republican base and to improve his popularity overall.  In doing so, the Governor will continue to delay the opportunity for approximately 600,000 residents to get comprehensive health coverage.  Some of the messages we need to get across are clear: (1) The current Medicaid program in Pennsylvania is efficient and works to provide comprehensive coverage to those who need it most; and (2) Pennsylvania residents will pay for Medicaid expansion through income tax regardless of whether we expand or not.  The government should expand in a way that provides the best services to individuals, not the highest profits for corporations.

 

Affordable Care Act, Health Policy, Health Reform, Inequality, Medicaid, Pennsylvania

Medicaid Expansion in Pennsylvania: Is it still possible?

budget letter photoToday, Pennsylvania Governor, Tom Corbett, announced his 2013-2014 proposed budget. During his budget address he announced that without further flexibility and reform from the federal government, expanding Medicaid in Pennsylvania would be, “financially unsustainable for Pennsylvania taxpayers”.  Governor Corbett’s announcement came a day after Republican Ohio Governor, John Kasich, announced that he would be expanding Medicaid in his state. Governor Kasich is the fifth Republican governor to do so.

While today’s announcement is certainly not good news for public health advocates, Corbett’s announcement did not entirely eliminate the possibility of expansion. In addition to his statement on the matter, Corbett sent a letter to HHS Secretary Sebelius identifying his concerns.

Corbett’s 2013-2014 proposed budget materials can be found here.

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Corbett’s Health Insurance Exchange Decision

Corbett’s Health Insurance Exchange Decision

Pennsylvania Governor, Tom Corbett, announced on December 12th that the Commonwealth will not be establishing its own Health Insurance Exchange. To most of us, this came as no surprise. Here’s the link to the Governor’s statement along with his letter to Secretary Sebelius. Within his letter, the Governor states his financial concerns of expanding Medicaid eligibility within the state. He cites to a $4 billion cost to the state over an eight year period. At this time the Governor has not decided whether Pennsylvania will expand Medicaid eligibility or not. 

Affordable Care Act, Essential Health Benefits, Health Reform, Pennsylvania

Pennsylvania’s Essential Health Benefits Package Progress (or lack thereof)

Previously, I provided information about the progress of Pennsylvania’s Health Insurance Exchange (HIX) implementation.  Today I received an email from Pennsylvania Insurance Department (PID) Commissioner, Michael Consedine, providing an update on the Commonwealth’s developments with the Essential Health Benefits (EHB) package and other health reform issues.

In his email, sent out through PAHealthOptions.com, the Insurance Commissioner provided links to three documents that should inform the reader of the “most recent activities of the department.”  The links included: 1. A report conducted by Deloitte on the EHB in Pennsylvania; 2. A letter to the HHS Secretary regarding the EHB; and 3. A letter to the HHS Secretary requesting more information about HIX implementation.  Following the links Commissioner Consedine assured the reader that, “We continue to be committed to pursuing health care reform solutions that work best for Pennsylvanians – but we are similarly committed to making sound, informed decisions – not just fast ones.”

The Deloitte study analyzed the Commonwealth’s choices of existing plans within the state to operate as the EHB as provided by HHS.  These include: 1. The largest plan by enrollment in any of the three largest small group insurance products in the State’s small group market; 2. One of the three largest State employee health benefit plans by enrollment; 3. One of the three largest federal employee insurer options; or 4. The largest HMO plan offered in the State’s commercial market.

Deloitte found that there was only a one percent difference between the total value or cost between the highest and lowest options; however coverage differences did exist among the plans, most notably for dental and specialized services including behavioral health. The study also found that all ten of the existing plans analyzed would need to be supplemented in order to meet requirements under the Affordable Care Act (ACA).

So, the question is: Which health plan will Pennsylvania choose as its Essential Health Benefits package? Like the letter to HHS about the Health Insurance Exchange, Commissioner Consedine, provides a similar answer. The Commissioner states, “Given what we believe to be the clear statutory obligation on HHS to define EHBs and the lack of any rulemaking that would allow Pennsylvania to make an informed and consequential decision by September 30th, we are simply providing the study conducted by the Commonwealth at this time.”  Commissioner Consedine also stated in his letter that he will be “directing interested parties to submit their comments and recommendations to you [HHS] for your consideration. . . ..”

In an ironic attempt to subvert a “one-sized fits all” Washington D.C. policy on the State of Pennsylvania, the Insurance Department has chosen to defer to Washington D.C. to craft the EHB package and will most likely default to a Federally-Facilitated Exchange (FFE) or a Partnership FFE.