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Should Pennsylvania Expand Medicaid? TV Smart Talk

Written by Nell McCormack Abom | Apr 3, 2013 10:45 AM

Should Pennsylvania join dozens of other states that have chosen to expand Medicaid eligibility under the Patient Protection and Affordable Care Act? It could provide health insurance coverage to 340,000 Pennsylvanians who currently lack an affordable option. Gov. Tom Corbett has been reluctant to expand the rolls because he fears it could leave Pennsylvania taxpayers on the hook for $500 million a year more in ever-growing Medicaid costs. We’ll delve into the Medicaid debate on Smart Talk, Thursday night at 8 on witf-TV. Be sure to join the conversation – post a comment here or to Facebook, Tweet, email us at smarttalk@witf.org, or call in live at 1-800-729-7532.

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Gov. Corbett on Tuesday met with U.S. Health and Human Services Secretary Kathleen Sebelius to ferret out more details on what an expansion of Medicaid would mean for the uninsured and for Pennsylvania’s taxpayers. The expansion would widen Medicaid’s income eligibility guidelines to 133 percent of the federal poverty level, or $31,300 for a family of four. The federal government would pick up the entire tab for the first three years of the expansion and then 90% of the cost after that time.

In his February budget address, and again in a statement released this morning, Corbett said, “Until we know whether or not significant reform is possible, I continue to have concerns that Pennsylvania’s Medicaid program will be able to serve, in a sustainable manner, the approximately one in four Pennsylvanians that would be covered under a full expansion.”  He noted that until he gets more information from HHS, "no further decisions will be made at this time." However, the governor expressed interest in using the private insurance market to expand coverage to the uninsured.  Arkansas and Tennessee, he pointed out, are pursuing that approach.

A study released last week by The Hospital & Healthsystem Association of Pennsylvania suggested that opting for expansion would lead to health insurance coverage for up to 350,000 low-income Pennsylvanians under the age of 65. The American Hospital Association paid for the study which was conducted by a unit of the RAND Corporation. The RAND report found that an expansion will bring up to $2.5 billion annually in federal payments to Pennsylvania, generate about $3 billion annually in economic activity, and help support nearly 40,000 jobs. "The bottom line is Medicaid expansion benefits the state's economy, provides a lifeline to Pennsylvania's most vulnerable citizens and is crucial to the fiscal health of Pennsylvania's safety net," claimed Paula Bussard, HAP senior vice president.

Our guests include Martin Ciccocioppo, vice president of research for the Hospital & Healthsystem Association of Pennsylvania.  Joining him in supporting Medicaid expansion from an economic, health policy and moral perspective is Antoinette Kraus, project manager of the Pennsylvania Health Access Network.

Presenting the opposing argument will be Priya Abraham, a senior policy analyst at the Commonwealth Foundation for Public Policy Alternatives.  The CF prefers that Medicaid convert to a federal block grant program that gives states maximum flexibility in managing it. Ms. Abraham warns that Medicaid "doesn't offer great quality of care and the projected costs of Medicaid expansion are being low-balled.  When other government programs are expanded, they tend to cost more than anticipated."   

Chris Comisac, deputy bureau chief for Capitolwire, an online subscription news service, recently wrote a comprehensive analysis piece in which he crunched the Medicaid numbers. Citing a Kaiser Family Foundation’s Commission on Medicaid and the Uninsured report from November 2012, Comisac wrote, “Pennsylvania’s Medicaid population during the next decade or so would be increased by approximately 370,000 adults just by the expansion of the program’s income eligibility - those are individuals not currently eligible for the entitlement. There are another 300,000 or more people who are currently eligible or who are made eligible by the ACA without expansion.”

Under Medicaid expansion, households with incomes less than 133 percent of the federal poverty level would meet Pennsylvania’s income eligibility. That group, Comisac reported, likely would capture a large number of able-bodied adults, heretofore, the very patients Pennsylvania lawmakers have gone out of their way to exclude from Medicaid eligibility.

Comisac made another point, one that is rarely mentioned in this debate. Even without expansion, some of those 370,000 uninsured Pennsylvanians have the option of getting insurance via federal subsidies for people who purchase health insurance through the ACA-mandated exchanges that are set to begin in 2014.

To put it into clear numbers, Comisac cited, “Those with incomes between 100 percent of federal poverty and 133 percent of the federal poverty level – a portion of the individuals who would otherwise be part of a Medicaid expansion – would only be required to pay two percent of their income toward the exchange insurance policy premium.”

Weigh in with your thoughts.  What do you want the governor to do about Medicaid?  Call 1-800-729-7532, email smarttalk@witf.org, Tweet, or post a comment to this article or on Facebook.

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Comments: 4

  • edstem09 img 2013-04-04 04:45

    Remember when Governor Rendell told us over and over agin that enabling gambling in PA would cut property taxes by 40% for most Pennsylvanians? Turned out to be utter baloney. Most homeowners get about $200 off. The casinos are even seeing a decline in gaming which will mean a decrease in property tax relief.

    This Medicaid expansion is the same false promises and big bills later.

    It is understandable that the hospitals would be all about this. They will be transferring the cost of uncompensated care onto the taxpayer's backs. The hospitals enjoy enormous local and state tax breaks and in exchange they are to provide this uncompensated care. If taxpayers are now to pay the bills, will hospitals be laying the property taxes?

  • edstem09 img 2013-04-04 04:59

    Advocates for this expansion claim that it will reduce costs because Medicaid patients will go to Doctor's offices, instead of being seen in the ER for minor problems.

    NOTHING in the law stops Medicaid patients from continuing to use the ERs. And they do as we have seen in Massachusetts.

    Nothing mandates that doctors must see Medicaid patients. They will still be paid 40 cents on the dollar. Meaning docs take a loss when they see Medicaid patients. While there are some rich doctors in specialties, family docs are usually the lowest earning medical doctors. Just like a store cold not survive by giving away 40% of its merchandise, these docs cannot pay their bills giving away large amounts of care.

    People go to ER's for non emergent problems because they cannot get an appointment at their doc's office. Going to the ER gets you seen that day.

    People go to the ER because their doctor's office or the local medical clinic is closed in the night or evenings, and on weekends and holidays. Many lower middle class folks cannot afford to take a day off to see a doc during daytime office hours.

    People go to the ER because they do not have a family doctor.

    People go to ERs because it takes everyone even those with Medicaid.

    Are people with Medicaid as healthy as or healthier than those who go without the coverage? No they are not.

  • jdeb img 2013-04-04 14:34

    If one sits back and does nothing because of “distrust” of the Federal Government, then some really good opportunities are lost. I vote unequivocally “yes” for accepting the Federal Government’s generous funding offer to the states for Medicaid expansion so that thousands more Pennsylvanians have health care coverage. Sure, the state insurance exchanges (another part of the Affordable Care Act) could be a part of the solution for low-income people, but I understand that our Governor has rejected the state’s chance to “do it our own way” with an exchange.

  • Robert Colgan img 2013-04-04 19:28

    Corbett is playing a very strange game here with the lives of the people in PA he's sworn to protect.
    Even though there is nothing in the Pennsylvania Constitution which says citizens have a right to coverage for medical need, and there is nothing which says the Governor has the right to deny citizens that coverage....a strong case can be argued that PA citizens have every right to be included--civil right--to the same protection afforded all US citizens through Medicaid.
    Medicaid can be the difference between someone losing their life, or their home, for lack of medical access or costs incurred by medical access when the need arises.

    Corbett's bases much of his refusal on genuine distortions of the truth: PA residents Medicaid costs are NOT more than the average American -- a false claim Corbett uses repeatedly.
    PA Medicaid costs will still be underwritten 90% even after the initial 3 year full coverage---making the future cost far less than the Governor claims.

    I hate political games that hurt people.
    Governor Corbett, do what is right for the citizens of PA and accept Medicaid on their behalf.

    Then resign.

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