(Harrisburg) -- From the rocky rollout of the new online insurance marketplace, to Governor Corbett's refusal to expand Medicaid, the Affordable Care Act made headlines throughout 2013.
As drafted, the federal Affordable Care Act envisioned across-the-board Medicaid expansion to cover adults with incomes up to 133 percent of the federal poverty line. But a 2012 ruling from the US Supreme Court made Medicaid expansion optional for states, and Pennsylvania is one of more than 20 states that have declined to make changes.
As a result, an estimated 400,000 Pennsylvanians earn too much to qualify for Medicaid, but too little to qualify for federal subsidies on the new insurance marketplace.
Kyle Fisher, a staff attorney for the Pennsylvania Health Law Project, says something is wrong with the way the system is operating.
"We're offering exchange subsidies to families with incomes of $60,000, $90,000, middle class, the upper middle class," he says. "But to those parents earning under $15,000 or $19,000 a year we're saying, sorry, we have nothing to offer you."
Governor Corbett has questioned the sustainability of Medicaid expansion since his February budget address. He says 1 in 6 Pennsylvanians is currently receiving Medicaid benefits, and that would jump to 1 in 4 under an expansion.
In September he unveiled a plan to use federal Medicaid expansion dollars to subsidize private health insurance for Pennsylvanians who are living below 133 percent of the federal poverty line.
"This isn't expanding an entitlement," Corbett said during a news conference at a downtown Harrisburg hospital. "This is a different program and this is one that makes common sense."
The governor’s so-called “Healthy PA” plan would also make changes to Pennsylvania’s existing Medicaid program, including a work-search requirement for most working-age recipients. The Corbett administration expects to submit the plan for federal approval after public hearings wrap up in mid-January.
The federal Department of Health and Human Services will have 30 days to review it.
Meanwhile, open enrollment began October first in Pennsylvania’s new federally-run health insurance marketplace for the uninsured and privately insured. It was one of the most highly anticipated dates in the rollout of the federal Affordable Care Act.
But even before the marketplace opened for business, experts warned the traffic at HealthCare.Gov might be hard to handle. Pinnacle Health’s legal services director, John DeLorenzo, stressed there was no need to panic if health insurance shoppers couldn’t enroll on day one.
“If you’re finding that the website’s slow or you can’t get on, you can come back another time," he said.
But midstaters experienced long delays, broken loops and error messages as the balky website’s problems dragged on through the fall.
Technical issues prevented Angela West of Camp Hill from comparing plans side-by-side as of late October. But the breast cancer survivor wouldn’t let herself get discouraged.
"I think the end result is more advantageous than just giving up, and saying it's not worth the fight," she explained.
Pennsylvania was one of 27 states to decline a state-run marketplace. Seven others opted for a state-federal partnership model.
Through November, nearly 12,000 Pennsylvanians had signed up for insurance through the new exchange, and Pennsylvania health care advocates say insurance plan enrollments under the federal health care law were surging around Christmastime.
Initially, users had until December 15th to enroll if they wanted the insurance they purchased on the marketplace to take effect on January 1st. That date was ultimately delayed until Christmas Eve.
Coverage will now start on February first for anyone who enrolls by mid-January.
Those who don’t have health insurance by the end of March may be subject to a penalty of $95 or one percent of household income, whichever is greater. The penalty for non-compliance with the individual mandate is scheduled to increase in subsequent years, under the Affordable Care Act.
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