Financial assistance is on the way to help some low-income people save on health care expenses in many states, but how many of Pennsylvania’s poor get assistance depends on whether the federal government accepts a plan Gov. Tom Corbett will unveil this week.
Corbett will propose using Medicaid dollars to buy private insurance policies for some of the working poor rather than expanding Medicaid under the Affordable Care Act.
The ACA, which requires most people to have health insurance or pay a penalty, is intended to help people who don’t have insurance or are under-insured. Saying Medicaid is bloated and too costly, Corbett has refused to expand the program and a Supreme Court ruling on the ACA prevents the federal government from forcing the states to do so.
At a community health care forum Friday at Bucks County Community College, state healthcare advocates said they believed Corbett was poised to announce his support for a version of Medicaid expansion, which is a key part of President Barack Obama’s 2010 signature law.
Corbett spokeswoman Lynn Lawson said the governor will unveil his plan in a series of announcements starting Monday, but denied his proposal would be an expansion of Medicaid.
“He is not expanding Medicaid. He’s committed to making changes that provide for reforms that ensure that there is access and quality health care plans for all Pennsylvanians. It’s about providing for everyone, but it will not be through a Medicaid expansion,” Lawson said.
Lawson declined to disclose details of the forthcoming plan. But The Associated Press quotes sources as saying the conditions Corbett will lay out include allowing Pennsylvania to use the new federal Medicaid dollars to help adults who are eligible under the expanding income guidelines to buy private health insurance from the online insurance marketplace, also called exchanges. Corbett also wants to require these enrollees to share the cost, for instance by paying a premium that is a percentage of their income, the sources said.
But first, Corbett will insist the Obama administration approves changes to Pennsylvania’s existing Medicaid program for working-age adults. Sources said he wants to require low-income, working-age adults already on Medicaid to search for work and pay a premium for their health insurance, according to the AP.
He also will propose improvements to the Children’s Health Insurance Program known commonly as CHIP.
One key change would eliminate a six-month waiting period before a child can get coverage. This would close the health insurance gap for an estimated 150,000 children in Pennsylvania who lack health care. And he’ll propose new ways to persuade medical school graduates to practice in parts of Pennsylvania that need more family doctors, according to sources.
Word of the Republican governor’s proposal arrives after Corbett aides spent months pressing the U.S. Department of Health and Human Services to allow Pennsylvania to adopt its own plan for expanding coverage to poor people who aren’t now eligible for Medicaid.
And Pennsylvania is not alone.
“Today, 26 states (including Pennsylvania) are not moving forward at this time (to expand Medicaid),” said Jennifer Tolbert, a health policy director for the nonpartisan Kaiser Family Foundation research organization. “The major implication of the Supreme Court decision is that there will be significant gaps in coverage among low-income adults in states that don’t expand Medicaid.”
Extra federal money becomes available Jan. 1 for states that participate in the Medicaid expansion. If HHS OKs the Corbett plan, it probably wouldn’t be ready to roll before 2015, his public welfare secretary, Beverly Mackereth, has said previously.
According to a March report by the nonprofit Rand Corp., expanding Medicaid would add 35,000 jobs and $3 billion in economic activity to Pennsylvania. Under the ACA’s Medicaid expansion, the federal government would pick up 100 percent of the cost for the first three years of expansion, phasing down to 90 percent by 2020.
As of now, health insurance marketplace subsidies are only available to those with incomes above the poverty level, which is about $11,500 for an individual. It’s estimated that 6.2 million uninsured people won’t get health insurance covered if all states don’t expand Medicaid, Tolbert said.
After examining the nation’s uninsured people based on their income, she said the foundation concluded that more than half of those without insurance have incomes that would qualify for coverage under a Medicaid expansion. Another 39 percent may be eligible for insurance premium subsidies in the marketplaces. And the remaining 10 percent have incomes above 400 percent of the poverty level, which means they’d be able to purchase coverage in the marketplaces, but wouldn’t be eligible for the subsidies.
Republican lawmakers in Arkansas first raised the idea of a private option to Medicaid and sent a proposal to the Obama administration earlier this month. No action has been taken on it yet.
Meanwhile, concerns are being raised about who will pay the difference if private insurance policies are more expensive than Medicaid coverage and how those private plans will reflect Medicaid guarantees of certain benefits and limits on cost-sharing, said Matt Salo of the National Association of Medicaid Directors in Washington, D.C.