Capitol reporter Mary Wilson covers Pennsylvania politics and issues at the Pennsylvania state capitol.
Since the governor began expressing his hesitation to expanding Medicaid in Pennsylvania, he's voiced his concern that allowing more people to enroll in it could make it too costly for the commonwealth.
But to hear the head of the state Department of Public Welfare tell it, the system is already unsustainable.
"We have a list of what the mandated services are that we provide. The optional list is as long," said Acting Secretary of DPW, Bev Mackereth, to a room full of county human services administrators in Harrisburg on Monday.
The comment helps explain why there continues to be so much back and forth between state and federal officials over adding hundreds of thousands of Pennsylvanians to Medicaid - it may be one thing that can prod the state to simplify its system.
"I see this as an opportunity to really reform some of the problems... that we've all seen in the current way our Medicaid system works," said Mackereth. "And if we do that, I think we can get to where we want to be."
That makes it seem as if a Medicaid expansion is almost inevitable, which Mackereth isn't certain is true, balking even at the idea of being able to say what a state-specific expansion would mean.
"The federal government has given us lots answers and lots of information," she said. "The problem is, the information is not specific to Pennsylvania. It's very general and every state is different."
She's is meeting with federal officials again this week, following up on last week's meeting between Gov. Corbett and U.S. Health and Human Services Secretary Kathleen Sebelius. Mackereth said she expects to receive answers to at least one question that has been central to discussions so far - whether or not the state would receive full federal compensation for the first few years of an expansion. Federal officials have suggested the state wouldn't be compensated in full because of its now-defunct adultBasic insurance program, which was in place at the time the Affordable Care Act was made law.
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